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.
As a Client Specific Claim Auditor, you will have an exciting opportunity to join the CVS Caremark Pharmacy Audit team. In this position you become a subject matter expert with client Performance Guarantees. You will facilitate the audit program, drive innovation, maintain and ensure adherence with state audit laws and federal regulations, conduct pharmacy outreaches, and finalize and send audit results. You will work with internal and external partners to ensure all areas of Performance Guarantees are met on a quarterly basis. Additionally, you will become familiar with the claim adjustment process and ensure process is compliant with client Performance Guarantees.
In this position, you will need to interpret CMS Guidance, understand Caremark's audit program, understand client's benefit design translates into claim adjudication, translate state audit laws, use these factors to make decisions to protect the client and execute the PG to perfection. This position is client facing and to be successful in this role, you will need to think independently, have strong communication skills, be highly motivated, and have a high level of attention to detail.
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.
- 1+ years of professional experience, preferably in a claims processing, a pharmacy setting, Pharmacy Benefit Management (PBM) or analytics role.
- Experience with Pharmacy Claims Processing.
- Experience with Pharmacy Benefit Management (PBM) industry.
- Bachelor's Degree in any field is preferred.
-Verifiable High School Diploma or GED required.
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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