Senior Pharmacy Claims & Benefits Specialist

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

Job summary

CVS Health is seeking a claims processor to research, review, and correct pharmacy-related claim issues ensuring accurate benefits and regulatory compliance. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

Responsibilities include executing routine and non-routine tasks for the Claim Benefit area, following area protocols, reviewing specified claims, and reporting discrepancies.

Qualifications

• 2+ years experience in a production environment.
• 2+ years medical claim processing experience.
• Ability to interpret data from reports and spreadsheets.

Responsibilities

• Research and correct pharmacy-related claim issues to ensure accurate benefit administration.
• Execute routine and non-routine business support tasks for the Claim Benefit area with limited supervision.
• Follow protocols to provide effective and timely support.
• Identify and report claim overpayments, underpayments, and irregularities.
• Work independently while meeting productivity and quality expectations.

Skills

Analytical skills

Attention to detail

Problem solving

Data interpretation

Communication skills

Independent worker

Education

Associate degree or equivalent experience

Tools

DG system

Job description

CVS Health is seeking a claims processor to research, review, and correct pharmacy-related claim issues ensuring accurate benefits and regulatory compliance. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

Responsibilities include executing routine and non-routine tasks for the Claim Benefit area, following area protocols, reviewing specified claims, and reporting discrepancies.