Senior Claim Benefit Specialist – Pharmacy RX

Job not on LinkedIn

🔥 12 hours ago

🏈 Alabama, Arizona, +42 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 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