Claim Reprocessing Coordinator, CVS Health

CVS Health

Location:
United States, Providence

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 31.30 USD / Hour

Save Job

Apply Position

Job Description:

As a Claim Reprocessing Coordinator at CVS Health, you will be responsible for the timely and accurate reprocessing of pharmacy claims to reduce bad debt and prevent future billing issues. This role emphasizes process improvement, training, and collaboration with internal and external partners. Strong organizational and communication skills are required.

Job Responsibility:

Timely and accurate reprocessing of pharmacy claims that require corporate edits
Perform work through RX Connect system on claims to identify trends and issues
Handle and resolve high priority reprocessing requests from internal and external sources
Reduce bad debt by editing claims with corrected information to prevent billing errors
Evaluate current practices and procedures to identify and implement process improvements
Keep process documents updated
Manage workflow within the team’s inbox and Reprocessing Database
Attend monthly stakeholder team meetings to ensure alignment
Provide training to new hires and team members
Assist with ServiceNow ticket volume.

Requirements:

2+ years professional experience, preferably in a retail pharmacy or pharmacy call center setting
2+ years using Excel and Outlook in a professional or academic setting
Active RI Pharmacy Technician II License
Active PTCB certification (CPhT)
Ability to complete work based on productivity standards (SLA) with minimal supervision
Ability to work individually or with a team to identify and define problems, evaluate alternatives, and implement practical, cost-effective solutions
Must live in RI, MA or CT.

Nice to have:

1+ year experience with RxConnect System
Ability to interact professionally with business partners (internally and externally)
Excellent verbal and written communication skills
Prompt and concise issue follow up
Ability to quickly make sound decisions while multitasking
Flexibility to adapt to a changing environment
Desire to seek continued professional growth
NCPDP - National Council of Prescription Drug Programs rejection familiarity.

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions) and an employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access.

Additional Information:

Job Posted:
May 17, 2025

Expiration:
June 01, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Claim Reprocessing Coordinator