Senior Pharmacy Claims & Benefits Analyst

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

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health in Ohio is seeking a Pharmacy Claims Specialist to review and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity targets.

You will perform routine and non-routine support for the Claim Benefit area, identify overpayments/underpayments, and follow established protocols.

Qualifications

• 2+ years medical claim processing experience.
• Experience in a production environment.
• Knowledge of pharmacy claims, benefits and adjustment processes.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• DG system claims processing experience.

Responsibilities

• Research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration.
• Execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Identify and report claim overpayments, underpayments and other irregularities.
• Follow area protocols, standards, and policies to provide timely support.

Skills

Attention to detail

Analytical skills

Problem solving

Communication skills

Education

Associate degree or equivalent experience

Job description

CVS Health in Ohio is seeking a Pharmacy Claims Specialist to review and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity targets.

You will perform routine and non-routine support for the Claim Benefit area, identify overpayments/underpayments, and follow established protocols.