CVS Health

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Pharmacy Claims Reviewer

at CVS Health

Posted: 6/3/2019
Job Reference #: 996753BR
Keywords: pharmacy

Job Description

Job Title :
Pharmacy Claims Reviewer
Job ID :
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Description :
Job Description
As a Consultant Pharmacy Claims Reviewer, you will review any pharmacy claims submitted through the CVS Health claims processing systems. You will identify and rectify claims inaccuracies that would result in client over-payment.

As a Consultant Pharmacy Claims Reviewer, you may:
- Contact pharmacies for proper documentation or re-submission of inaccurate claims information in a timely manner.
- Monitor assigned clients and report status on a regular basis. Failure to meet contract performance guarantees results in financial penalties.
- Review pharmacy claims for centralized daily review processes.
- Work closely with internal and external customers to directly impact departmental success.

In addition, the pharmacy claims auditor is responsible for providing continual feedback to management regarding pharmacy trends, new drug write-ups to educate the team and assist on ad hoc projects.

Required Qualifications
- 1+ years of professional experience, preferably in a retail pharmacy setting

Preferred Qualifications
- Knowledge of LTC and PBM industries
- 2+ years of Pharmacy experience
- Knowledge of CVS Health (or other Pharmacy Benefit Management) claims processing systems
- Excellent communication skills
- Ability to work and make decisions independently with a self-starter mentality

Verifiable High School Diploma or GED required. Bachelor's Degree preferred.

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!