Senior Pharmacy Claims Benefit Specialist

CVS Health; Missouri; Hybrid; USD 26,000 - 54,000; Full time

Benefits offered by this job

Bonus program

Job summary

CVS Health is seeking a claims support professional to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance.

The role emphasizes analytic rigor, attention to detail, and the ability to work independently while meeting productivity and quality expectations. It is a full-time position with a comprehensive benefits package and potential bonus participation.

Qualifications

• 2+ years in a production environment.
• 2+ years medical claim processing experience.
• Knowledge of pharmacy claims, benefits, and adjustment processes.
• Attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities and work independently.

Responsibilities

• Executes routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews pre-specified claims or those beyond adjudication authority.
• Identifies and reports claim overpayments, underpayments, and other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Analytical thinking

Attention to detail

Data interpretation

Written & verbal communication

Independent work

Problem solving

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a claims support professional to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance.

The role emphasizes analytic rigor, attention to detail, and the ability to work independently while meeting productivity and quality expectations. It is a full-time position with a comprehensive benefits package and potential bonus participation.