Senior Pharmacy Claims & Benefit Specialist

CVS Health; North Carolina; Híbrido; USD 26.000 - 54.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Descripción de la vacante

CVS Health is seeking an experienced claims specialist to research, review and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role emphasizes strong analysis, attention to detail, and independent work to meet productivity and quality expectations.

The position supports the Claim Benefit area with routine and non-routine tasks, compliance with protocols, and timely resolution of discrepancies.

Formación

• 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.
• DG system claims processing experience.

Responsabilidades

• Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
• Identifies and reports claim overpayments, underpayments, and any other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Conocimientos

Production environment

Medical claim processing

Analytical skills

Attention to detail

Communication skills

Independent work

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health is seeking an experienced claims specialist to research, review and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role emphasizes strong analysis, attention to detail, and independent work to meet productivity and quality expectations.

The position supports the Claim Benefit area with routine and non-routine tasks, compliance with protocols, and timely resolution of discrepancies.