Senior Pharmacy Claims & Benefits Expert

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

Job summary

CVS Health is seeking a claims analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The role demands strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality standards.

Responsibilities include executing routine and non-routine tasks for the Claim Benefit area, following established protocols, reviewing specified claims, identifying

Qualifications

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

Responsibilities

• Executes routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• 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

Production experience

Medical claim processing

Education

Associate degree or equivalent

Tools

DG system claims processing

Job description

CVS Health is seeking a claims analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The role demands strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality standards.

Responsibilities include executing routine and non-routine tasks for the Claim Benefit area, following established protocols, reviewing specified claims, identifying