CVS Health
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.
Position Summary As a Pharmacy Insurance Specialist, you will be responsible for ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system. The Pharmacy Insurance Specialist will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements. As a part of the Network Operations team, this role allows you to analyze third party programs, and investigate and resolve systemic issues relative to prescription claims processing that interfaces with stores, providers, patients, pricing and financial impacts to the company.
Responsibilities
Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations.
Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims processing support for all system related issues or enhancements including defining business scenarios and testing procedures, analyzing production issues for any potential causes and recreating all known defects in test environments to assist development.
Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results.
Hybrid Work This role is considered 'hybrid' with the expectation to be onsite Tuesday and Wednesday of the work week.
Required Qualifications
1+ year related experience in pharmacy, PBM, or insurance.
1+ years of experience using Microsoft Word and Excel.
Preferred Qualifications
3+ years of related experience in pharmacy, PBM, or insurance.
Previous experience with business-to-business, interdepartmental, or customer interactions.
Experience working in a high volume environment (e.g., pharmacy technician, medical billing).
Experience with SQL or Access.
Experience creating effective presentations.
Education Associate’s Degree or Related Experience Required.
Weekly Hours 40.
Time Type Full time.
Pay Range $43,888.00 - $93,574.00.
Benefits Affordable medical plan options, a 401(k) plan with matching company contributions, and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
We anticipate the application window for this opening will close on: 10/31/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Position Summary As a Pharmacy Insurance Specialist, you will be responsible for ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system. The Pharmacy Insurance Specialist will perform extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements. As a part of the Network Operations team, this role allows you to analyze third party programs, and investigate and resolve systemic issues relative to prescription claims processing that interfaces with stores, providers, patients, pricing and financial impacts to the company.
Responsibilities
Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations.
Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims processing support for all system related issues or enhancements including defining business scenarios and testing procedures, analyzing production issues for any potential causes and recreating all known defects in test environments to assist development.
Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results.
Hybrid Work This role is considered 'hybrid' with the expectation to be onsite Tuesday and Wednesday of the work week.
Required Qualifications
1+ year related experience in pharmacy, PBM, or insurance.
1+ years of experience using Microsoft Word and Excel.
Preferred Qualifications
3+ years of related experience in pharmacy, PBM, or insurance.
Previous experience with business-to-business, interdepartmental, or customer interactions.
Experience working in a high volume environment (e.g., pharmacy technician, medical billing).
Experience with SQL or Access.
Experience creating effective presentations.
Education Associate’s Degree or Related Experience Required.
Weekly Hours 40.
Time Type Full time.
Pay Range $43,888.00 - $93,574.00.
Benefits Affordable medical plan options, a 401(k) plan with matching company contributions, and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
We anticipate the application window for this opening will close on: 10/31/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr