Senior Pharmacy Claims & Benefits Specialist

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

Job summary

CVS Health is hiring for a full-time role in Wisconsin focused on researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration 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 routine and non-routine support tasks for the Claim Benefit area, adherence to protocols, and reporting any claim

Qualifications

• 2+ years experience in a production environment.
• 2+ years medical claim processing experience.
• Knowledge of pharmacy claims processing preferred.
• Attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities and work independently.

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 skills

Attention to detail

Problem solving

Written communication

Verbal communication

Independent work

Data interpretation

Education

Associate degree or equivalent experience

Job description

CVS Health is hiring for a full-time role in Wisconsin focused on researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration 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 routine and non-routine support tasks for the Claim Benefit area, adherence to protocols, and reporting any claim