Analyst, Network Management

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.

Position Summary

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans, and community pharmacists, we're pioneering a bold new approach to total health. Making quality care more affordable, accessible, simply and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

The Pharmacy Claims Reviewer is responsible for reviewing pharmacy claims submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that would result in client over-payment.

In order to be successful in this role you will contact pharmacies for proper documentation to ensure a claim was submitted correctly as well as monitor assigned clients and report status on a regular basis. In the event of an inaccurate claim submission, you will follow the appropriate Policies.

We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays.

This is a Hybrid role and will require onsite training and regular team meetings.

Required Qualifications

• 2 plus years retail or PBM pharmacy experience

• Previous experience with Microsoft Office Suite including Outlook, Excel, etc.

Preferred Qualifications

• Certified Pharmacy Technician

• Ability to multitask and work independently

• Effective communication skills

• Previous pharmacy experience

Education

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is:

$40,600.00 - $85,100.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits.

Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/17/2024