Pharmacy Insurance Specialist-1
| Company | CVS Health |
|---|---|
| Location | Smithfield, RI, USA |
| Salary | $43888 – $93574 |
| Type | Full-Time |
| Degrees | Associate’s |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- 1+ year related experience in pharmacy, PBM, or insurance
- 1+ years of experience using Microsoft Word and Excel
Responsibilities
- Ensuring that all required third party insurance settings are coded and maintained appropriately within the pharmacy adjudication system
- Performing extensive testing and documentation to ensure accurate prescription claims processing while remaining in compliance with pharmacy standards and payer requirements
- Receiving third party program contract updates and creating or modifying third party plan configurations necessary to comply with industry standards, contract agreements and state and federal regulations
- Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims processing support for all system related issues or enhancements including defining business scenarios and testing procedures, analyzing production issues for any potential causes and recreating all known defects in test environments to assist development
- Working cross-functionally within the department to provide quality assurance within Pharmacy Operations by executing various scenarios affecting data quality, prescription claim processing and providing in-depth analysis of the results
Preferred Qualifications
- 3 + years of related experience in pharmacy, PBM, or insurance
- Previous experience with business-to-business, interdepartmental, or customer interactions
- Experience working in a high volume environment (ie. pharmacy technician, medical billing)
- Experience with SQL or Access
- Experience with creating effective presentations
- Associates or equivalent experience