Remote Specialty Pharmacy Claims Processing Technician
Company: CVS Health
Location: United States
Employment Type: FULL_TIME, PART_TIME
Date Posted: 2025-11-07
Valid Through: 2026-11-07
Job Summary
CVS Health is seeking a dedicated Remote Specialty Pharmacy Claims Processing Technician to join our growing specialty pharmacy team. This role is ideal for detail-oriented professionals who are passionate about ensuring accuracy and efficiency in processing complex pharmacy claims. As a key member of our pharmacy operations unit, you will handle claim adjudication, insurance verifications, and prior authorization submissions to support patients in accessing their specialty medications promptly and affordably. Working remotely, you will collaborate with pharmacists, payers, and healthcare providers to ensure a smooth and compliant claims process that aligns with CVS Health mission to improve the lives of those we serve.
Key Responsibilities
Accurately process and adjudicate specialty pharmacy claims according to payer guidelines and company policies.
Verify insurance coverage, benefits, and eligibility for specialty medications.
Resolve rejected or denied claims by communicating with insurance carriers, prescribers, and patients.
Assist pharmacists and clinical teams with claim status updates and reimbursement coordination.
Maintain up-to-date knowledge of claim codes, NDC numbers, and payer-specific processing requirements.
Identify and escalate claim discrepancies, trends, or recurring denials to management for resolution.
Document claim activities and communications in pharmacy systems with accuracy and compliance.
Support prior authorization submissions and follow-ups as needed.
Ensure all activities adhere to HIPAA and company confidentiality standards.
Required Skills and Qualifications
Active Pharmacy Technician Certification (CPhT) or state-registered pharmacy technician license required.
High school diploma or equivalent required; associate degree preferred.
Proven experience in pharmacy claims processing, adjudication, or insurance verification within a retail, mail-order, or specialty pharmacy setting.
Strong understanding of pharmacy billing systems, third-party insurance, and prior authorization workflows.
Excellent computer proficiency with pharmacy management systems and Microsoft Office Suite.
Exceptional attention to detail, accuracy, and organizational skills.
Strong written and verbal communication abilities to interact effectively with patients, providers, and payers.
Experience
Minimum 2 years of experience in pharmacy claims processing or related pharmacy operations role, preferably in a specialty pharmacy environment.
Experience with high-volume claims adjudication systems and complex benefit coordination processes is highly desirable.
Working Hours
Remote, Full-Time Position (40 hours per week).
Flexible schedule options may be available based on business needs.
Some evening or weekend shifts may be required to meet operational demands.
Knowledge, Skills, and Abilities
Comprehensive understanding of pharmacy claim workflows and insurance billing.
Strong analytical and problem-solving skills for claim discrepancies.
Ability to multitask and prioritize in a fast-paced, deadline-driven environment.
Commitment to maintaining confidentiality and ensuring compliance with HIPAA regulations.
Team-oriented mindset with the ability to work independently under minimal supervision.
Benefits
Competitive hourly pay with performance-based incentives.
Comprehensive medical, dental, and vision insurance.
Paid time off, holidays, and sick leave.
401(k) plan with company match.
Employee discounts on CVS Health products and pharmacy services.
Career advancement opportunities and ongoing professional development programs.
Supportive and inclusive remote work culture.
Why Join CVS Health
At CVS Health, you will be part of a mission-driven organization that values your expertise, compassion, and dedication to improving patient care. Working remotely as a Specialty Pharmacy Claims Processing Technician allows you to play a vital role in helping patients access life-changing medications while enjoying work-life balance and career stability. Join a team that invests in your growth and empowers you to make a difference in peoples lives every day.
How to Apply
Interested candidates are encouraged to apply online through the CVS Health Careers Portal.
Visit https://jobs.cvshealth.com
Search for Remote Specialty Pharmacy Claims Processing Technician
Complete the online application form and upload your updated resume.
