Senior Pharmacy Claims & Benefits Specialist

CVS Health; Montana; Hybrid; USD 25,000 - 54,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a claims specialist to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. You will analyze data, follow established protocols, and contribute to timely, high-quality support within the Claim Benefit area.

The role emphasizes attention to detail, analytical skills, and the ability to work independently in a fast-paced environment with full-time hours and a strong benefits package.

Qualifications

• Minimum 2+ years in a production environment.
• Minimum 2+ years of medical claim processing experience.
• Associate degree or equivalent experience required.

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.
• Takes direction to implement techniques, processes and responsibilities.

Skills

Pharmacy claims knowledge

Attention to detail

Analytical thinking

Data interpretation

communication skills

multitasking

independent work

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a claims specialist to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. You will analyze data, follow established protocols, and contribute to timely, high-quality support within the Claim Benefit area.

The role emphasizes attention to detail, analytical skills, and the ability to work independently in a fast-paced environment with full-time hours and a strong benefits package.