Senior Pharmacy Claims & Benefit Specialist

CVS Health; New Mexico; On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a detail-oriented claims processor to support the Claim Benefit area. The role requires handling routine and non-routine tasks, reviewing claims, and ensuring accurate benefit administration.

Ideal candidates have at least 2+ years in medical claim processing, strong analytical abilities, and the capacity to work independently while maintaining productivity and quality expectations. Full-time position with comprehensive benefits.

Qualifications

• 2+ years of experience in a production environment.
• 2+ years medical claim processing experience.
• Knowledge of pharmacy claims, benefits, and adjustment processes (preferred).
• Strong analytical and problem-solving skills (preferred).
• Effective written and verbal communication skills (preferred).

Responsibilities

• Execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Follow area protocols, standards, and policies to provide effective and timely support.
• Review pre-specified claims or claims that exceed adjudication authority or processing expertise.
• Identify and report claim overpayments, underpayments, and other irregularities.
• Take direction to execute techniques, processes, and responsibilities.

Skills

Production experience

Medical claim processing

Analytical skills

Attention to detail

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a detail-oriented claims processor to support the Claim Benefit area. The role requires handling routine and non-routine tasks, reviewing claims, and ensuring accurate benefit administration.

Ideal candidates have at least 2+ years in medical claim processing, strong analytical abilities, and the capacity to work independently while maintaining productivity and quality expectations. Full-time position with comprehensive benefits.