Senior Pharmacy Claims & Benefits Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Claims Benefit Analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The role emphasizes strong analytical skills and independent work habits.

This full-time position involves executing routine and complex tasks, following established protocols, and identifying payment discrepancies while maintaining productivity and quality.

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.
• DG system claims processing experience.

Responsibilities

• Executes 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.

Skills

Medical claim processing

Production environment experience

Attention to detail

Analytical thinking

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a Claims Benefit Analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The role emphasizes strong analytical skills and independent work habits.

This full-time position involves executing routine and complex tasks, following established protocols, and identifying payment discrepancies while maintaining productivity and quality.