As the pharmacy bases, vials and long term care auditor you are responsible for reviewing all claims in these categories. You will be expected to understand how the pharmacies operate on a daily basis -including but not limited to retail, outpatient, long term care. In addition, the claims reviewer is responsible for handling various internal and external partner claim review requests as they relate to certain claims and any ad hoc requests. Additionally, the pharmacy bases, misc vials and long term care claims auditor is responsible for handling such requests from start to finish including oversight of the claim review process and architecture, conducting pharmacy outreaches in conjunction with other team members, claim review quality control, summarizing and finalizing claim review results while ensuring the claim is correctly processed as a result of the review. This specific position will carry the bulk of the reviews for long term care daily review. Identifying trends and cross training within the daily review processes.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- 2+ years of pharmacy experience, preferably in a pharmacy claims role
- Certified Pharmacy Technician License Preferred
COVID Vaccine Required :
COVID Requirements :
Preferred Qualifications :
- Knowledge of PBM industries
- 2+ years of Pharmacy experience
- Knowledge of CVS Health (or other Pharmacy Benefit Management) claims processing systems
- Excellent verbal and written communication skills
- Strong math skills
- Ability to work and make decisions independently with a self-starter mentality
- Comfortable with confrontation and able to diffuse situations independently
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
- Knowledge of CVS Health (or other Pharmacy Benefit Management) claims processing systems.
- Bachelors Degree preferred.
- Bachelors Degree preferred.
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.