[Hiring] Senior Claim Benefit Specialist @CVS Health

Role Description

Responsible for researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration, financial accuracy, and compliance with client and regulatory requirements. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

• Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers.
• 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.

Qualifications

• 2+ years experience in a production environment.
• 2+ years medical claim processing experience.

Requirements

• Knowledge of pharmacy claims, benefits, and adjustment processes.
• 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.
• DG system claims processing experience.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.