Senior Pharmacy Claims & Benefit Specialist

CVS Health; Vermont; Hybride; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Bonus eligibility

Résumé du poste

CVS Health is seeking an experienced claims processor to research, review, and correct pharmacy-related claim issues for accurate benefit administration and compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality targets.

You will handle routine and non-routine tasks, follow established protocols, review complex claims, identify discrepancies, and execute required processes under supervision.

Qualifications

• 2+ years of experience in a production environment.
• 2+ years medical claim processing experience.

Responsabilités

• Executes routine and non-routine business support tasks for the Claim Benefit area.
• 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 other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Connaissances

Attention to detail

Analytical skills

Strong communication

Formation

Associate degree or equivalent

Outils

DG system claims processing

Description du poste

CVS Health is seeking an experienced claims processor to research, review, and correct pharmacy-related claim issues for accurate benefit administration and compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality targets.

You will handle routine and non-routine tasks, follow established protocols, review complex claims, identify discrepancies, and execute required processes under supervision.