Senior Pharmacy Claims & Benefit Specialist

CVS Health; New York (NY); Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Pharmacy Claims Processor to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality expectations.

This full-time position offers a comprehensive benefits package and bonus eligibility; typical weekly hours are 40 with a pay range of $18.50–$38.82 per hour, depending on experience, location, and other factors.

Qualifications

• 2+ years in a production environment.
• 2+ years medical claim processing experience.
• Knowledge of pharmacy claims, benefits, and adjustment processes.

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 claims that exceed specialist adjudication authority.
• Identifies and reports claim overpayments, underpayments, and any other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Production experience

Medical claim processing

Education

Associate degree

Tools

DG system

Job description

CVS Health is seeking a Pharmacy Claims Processor to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality expectations.

This full-time position offers a comprehensive benefits package and bonus eligibility; typical weekly hours are 40 with a pay range of $18.50–$38.82 per hour, depending on experience, location, and other factors.