Claim Reprocessing Coordinator - RI, MA or CT - Pharmacy Tech II RI License Required

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. And we do it all with heart, each and every day. Job Licensing/Certification Requirements Active RI Pharmacy Technician II License. Active PTCB certification (CPhT). Position Summary As a Claim Reprocessing 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. You will be responsible for evaluating current practices and procedures, to identify and implement team process improvements and keeping process documents updated. The Claim Reprocessing Coordinator will manage workflow within the team’s inbox and Reprocessing Database. Additionally, you will attend monthly Reprocessing stakeholder team meetings, with internal teams, to ensure alignment. You will provide training to new hires and established team members as needed. The Claim Reprocessing Coordinator will assist with ServiceNow ticket volume. As you will work with reduced supervision; you must possess strong organizational and communication skills with the capability to provide feedback for process improvements to management. Required Qualifications 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. Preferred Qualifications 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. Education Verifiable High School Diploma or GED is required. Bachelor’s degree is preferred in Accounting, HealthCare, Finance, or Business. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $31.30 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including 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. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 09/01/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

Apply Now

Apply Now