Pharmacy Benefit Specialist

Join our team at CVS Wellbeing as a Pharmacy Benefit Specialist! This is a remote opportunity with an immediate start, offering a competitive salary of $26-$35 per hour. We are seeking a talented and detail-oriented individual to ensure accurate pharmacy claims processing and contribute to our mission of improving healthcare for everyone.

Job Responsibilities:

As a Pharmacy Benefit Specialist, you will be responsible for guaranteeing that all expected external pharmacy settings are coded and kept suitably within the pharmacy settlement framework. You will perform broad testing and documentation to guarantee exact prescription claims handling while staying consistent with pharmacy principles and payer prerequisites.

As part of the Organization Operations team, this role allows you to analyze external programs, research and resolve foundational issues related to prescription claims handling that involves interaction with stores, suppliers, patients, pricing, and financial impacts on the organization.

Key responsibilities include

• Receiving external program contract updates and creating or modifying external plan designs to align with industry standards, contract arrangements, and state and government regulations.
• Working with Pharmacy Application Development teams in Information Systems (IS) to provide prescription claims handling support for all system-related issues or enhancements, including defining business scenarios and testing methods, analyzing production issues for root causes, and reproducing all identified defects in test conditions to support development.
• Working cross-functionally within the division to provide quality affirmation within Pharmacy Operations by executing various scenarios influencing data quality, prescription guarantee handling, and providing in-depth analysis of the outcomes.

This job is considered 'hybrid' with the expectation for the associate to be in the office on Tuesday, Wednesday, and Thursday of the work week.

Required Skills:

• 1+ years of related experience in a pharmacy, PBM, or insurance environment.
• 1+ years of experience utilizing Microsoft Word and Excel.

Preferred Skills:

• 3+ years of related experience in a pharmacy, PBM, or insurance environment.
• Prior experience in business, interdepartmental, or client communications.
• Experience working in a high-volume environment (e.g., pharmacy professional, clinical billing).
• Experience with SQL or Access.
• Experience with creating successful presentations.

Training & Qualifications:

Training Partner's certificate or related experience required.

About CVS Wellbeing:

At CVS Wellbeing, we share a common, clear purpose: Carrying our heart to each snapshot of your well-being. This purpose guides our commitment to deliver improved human-driven healthcare for a rapidly changing world. We believe in fostering a culture of diversity, inclusion, and belonging. CVS Wellbeing is an equal opportunity employer and is committed to providing a workplace free from discrimination.

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