Senior Pharmacy Claims & Benefits Specialist

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

Job summary

CVS Health in Colorado is seeking a Pharmacy Claims Processor to research, review and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance with client and regulatory requirements. The role demands strong analysis, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

Daily responsibilities include executing routine and non-routine claims tasks, following area protocols, reviewing claims,

Qualifications

• 2+ years 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

Analytical thinking

Attention to detail

Problem-solving

Effective communication

Multi-tasking

Independent work

Education

Associate degree or equivalent experience

Tools

DG system

Claims processing software

Job description

CVS Health in Colorado is seeking a Pharmacy Claims Processor to research, review and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance with client and regulatory requirements. The role demands strong analysis, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

Daily responsibilities include executing routine and non-routine claims tasks, following area protocols, reviewing claims,