Senior Pharmacy Claims Benefits Specialist

CVS Health; Kansas; Hybrid; USD 26,000 - 52,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid time off

Job summary

CVS Health is seeking a detail‑oriented claims processor to research, review, and correct pharmacy-related claim issues, ensuring accurate benefits administration and regulatory compliance. The role emphasizes analytical thinking, data interpretation from reports, and independent work to meet productivity and quality standards.

Responsibilities include handling routine and complex claims, identifying discrepancies, and adhering to protocols.

Qualifications

• 2+ years of production environment experience.
• 2+ years medical claim processing experience.
• Strong attention to detail and accuracy.
• Analytical and problem-solving abilities.
• Effective written and verbal communication skills.

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 those beyond adjudication authority.
• Identifies and reports claim overpayments, underpayments, and irregularities.
• Follows directions to execute techniques, processes, and responsibilities.

Skills

Production experience

Medical claim processing

Attention to detail

Analytical skills

Communication skills

Multi-tasking

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a detail‑oriented claims processor to research, review, and correct pharmacy-related claim issues, ensuring accurate benefits administration and regulatory compliance. The role emphasizes analytical thinking, data interpretation from reports, and independent work to meet productivity and quality standards.

Responsibilities include handling routine and complex claims, identifying discrepancies, and adhering to protocols.