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Pharmacy Claims Coordinator

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Providence

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Category:
Customer Service

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Contract Type:
Employment contract

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Salary:

17.00 - 31.30 USD / Hour
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Job Description:

As a Pharmacy Claims Coordinator, you will be responsible for the timely and accurate reprocessing of pharmacy claims that require corporate edits. In this role, you will perform work through our RX Connect system on claims to identify trends and issues. Your tasks will include the handling and resolution of high priority Reprocessing requests from both internal and external sources. The main priority of this role is to reduce bad debt by editing claims with corrected information which will prevent future fills from being billed incorrectly.

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 both internal and external sources
  • Reduce bad debt by editing claims with corrected information
  • Evaluate current practices and procedures to identify and implement team process improvements
  • Keep process documents updated
  • Manage workflow within the team's inbox and Reprocessing Database
  • Attend monthly Reprocessing stakeholder team meetings
  • Provide training to new hires and established team members
  • Assist with ServiceNow ticket volume

Requirements:

  • Active RI Pharmacy Technician II License
  • Active PTCB certification (CPhT)
  • 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
  • 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
  • Verifiable High School Diploma or GED is required

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
  • Bachelor's degree in Accounting, HealthCare, Finance, or Business
What we offer:
  • Affordable medical plan options
  • 401(k) plan with matching company contributions
  • Employee stock purchase plan
  • No-cost 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:
September 27, 2025

Expiration:
January 01, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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