Senior Claim Benefit Specialist – Pharmacy RX

CVS Health

. Research, review, and correct pharmacy-related claim issues .

Posted 10/19/2026full-timeRemote • United StatesSenior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy claims processing, ensuring compliance with regulatory requirements and accurate benefit administration. Strong analytical skills and attention to detail are essential for identifying and resolving claim discrepancies.

Highest-signal resume keywords

Medical Claim Processing ExperiencePharmacy Claims KnowledgeAttention To DetailAnalytical SkillsDG System Claims Processing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim ReviewBenefit AdministrationFinancial AccuracyData InterpretationClaims Adjustment Processes

Soft Skills

Problem-Solving SkillsEffective CommunicationAbility To Manage Multiple PrioritiesIndependence

Certifications & Qualifications

Associate Degree

Industry Keywords

Regulatory CompliancePharmacy BenefitsClaim OverpaymentsClaim UnderpaymentsProduction Environment

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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