Senior Claim Benefit Specialist – Pharmacy RX

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Conduct research, review, and rectify pharmacy-related claim discrepancies.

• Ensure the accurate administration of benefits, financial precision, and compliance with both client and regulatory standards.

• Perform routine and non-routine business support tasks for the Claim Benefit area with limited supervision.

• Escalate deviations from standard practices to management.

• Adhere to established protocols, standards, and policies in the area.

• Evaluate pre-defined claims or those surpassing specialist adjudication authority or processing expertise.

• Detect and report claim overpayments, underpayments, and any other inconsistencies.

• Implement techniques, processes, and responsibilities as instructed.

• Achieve productivity and quality benchmarks while working autonomously.

⛳️ Requirements

• Over 2 years of experience in a production setting.

• More than 2 years of experience in medical claim processing.

• An associate degree or equivalent professional experience.

• Familiarity with pharmacy claims, benefits, and adjustment procedures.

• Strong attention to detail and commitment to accuracy.

• Excellent analytical and problem-solving abilities.

• Capability to interpret data from reports and spreadsheets.

• Proficient written and verbal communication skills.

• Ability to juggle multiple priorities and work independently.

• Experience with DG system claims processing.

🏝️ Benefits

• Participation in CVS Health bonus, commission, or short-term incentive programs in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

• Additional resources for physical, emotional, and financial well-being, subject to eligibility.