Senior Claim Benefit Specialist – Pharmacy RX
Job Description:
- Research, review, and correct pharmacy-related claim issues
- Ensure accurate benefit administration, financial accuracy, and compliance with client and regulatory requirements
- Execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision
- Refer deviations from standard practices to managers
- Follow area protocols, standards, and policies
- Review pre-specified claims or claims exceeding specialist adjudication authority or processing expertise
- Identify and report claim overpayments, underpayments, and other irregularities
- Execute techniques, processes, and responsibilities as directed
- Meet productivity and quality expectations while working independently
Requirements:
- 2+ years of experience in a production environment
- 2+ years of medical claim processing experience
- Associate degree or equivalent experience
- 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:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
