Senior Pharmacy Claims & Benefits Analyst

CVS Health; Massachusetts; Hybrid; USD 25,000 - 53,000; Full time

Job summary

CVS Health in Massachusetts is seeking a detail-oriented claims analyst to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. This full-time role requires strong analytical skills and independent work.

You will handle routine and non-routine tasks, identify overpayments or underpayments, follow established protocols, and contribute to a compliant, customer-focused health experience.

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.
• Experience with DG system claims processing.

Responsibilities

• Research, review, and correct pharmacy-related claim issues.
• 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 specialist adjudication authority or processing expertise.
• Identify and report claim overpayments, underpayments, and any other irregularities.
• Take direction to execute techniques, processes, and responsibilities.

Skills

Claims processing

Analytical skills

Attention to detail

Communication skills

Independent work

Education

Associate degree or equivalent experience

Tools

DG system

Job description

CVS Health in Massachusetts is seeking a detail-oriented claims analyst to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. This full-time role requires strong analytical skills and independent work.

You will handle routine and non-routine tasks, identify overpayments or underpayments, follow established protocols, and contribute to a compliant, customer-focused health experience.