Virtual Pharmacy Technician - Claims Adjudication Specialist
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 detail-oriented and customer-focused Virtual Pharmacy Technician – Claims Adjudication Specialist to join our remote pharmacy operations team. In this role, you will play a crucial part in ensuring accurate, timely, and compliant processing of prescription claims. You will handle complex adjudication issues, assist healthcare providers and patients with claim resolutions, and ensure seamless coordination between payers, pharmacies, and customers. This position is ideal for certified pharmacy technicians who thrive in a fast-paced digital environment and are passionate about improving patient access to medication.
Key Responsibilities
Accurately review, process, and adjudicate prescription claims using CVS Healths electronic systems.
Investigate claim denials, rejections, and prior authorization requirements to identify resolution pathways.
Communicate effectively with healthcare providers, insurance companies, and patients to resolve claim-related issues.
Verify prescription data, coverage details, copay amounts, and eligibility for medication benefits.
Collaborate with internal departments to ensure compliance with state and federal pharmacy regulations.
Maintain patient confidentiality and adhere to HIPAA and CVS Healths data protection policies.
Provide exceptional customer service by offering clear explanations and timely updates on claim status.
Document claim activities accurately and report unresolved issues to senior pharmacy or operations staff.
Required Skills and Qualifications
Active Pharmacy Technician Certification (CPhT) through PTCB or ExCPT.
High school diploma or equivalent required; associate degree preferred.
Strong understanding of prescription claims processing and insurance adjudication workflows.
Excellent computer proficiency with pharmacy management software and digital communication tools.
Strong written and verbal communication skills with a customer-first mindset.
Ability to work independently, manage multiple priorities, and meet deadlines in a virtual environment.
Experience
Minimum 2+ years of experience as a Pharmacy Technician, preferably in claims adjudication, reimbursement support, or insurance verification.
Previous experience in a remote or call center pharmacy environment is highly desirable.
Working Hours
Flexible remote schedule, with core working hours between 8:00 AM and 8:00 PM (local time zone).
May require rotating weekends or evening shifts based on business needs.
Knowledge, Skills, and Abilities
Deep understanding of pharmacy benefit management (PBM) systems and claim adjudication processes.
Knowledge of Medicare, Medicaid, and commercial insurance coverage guidelines.
Ability to analyze data, identify trends, and implement corrective actions for claim accuracy.
Strong organizational skills, attention to detail, and problem-solving abilities.
Commitment to maintaining a high level of professionalism, accuracy, and confidentiality.
Benefits
Competitive pay package with performance-based incentives.
Comprehensive health, dental, and vision insurance.
401(k) retirement savings plan with company match.
Paid time off, holidays, and wellness programs.
Employee discounts on CVS Health products and pharmacy services.
Opportunities for professional development, certification reimbursement, and career growth.
Why Join CVS Health
At CVS Health, we are redefining the future of pharmacy by blending innovation, compassion, and technology to improve patient outcomes. As part of our virtual pharmacy team, you will work in a supportive, inclusive, and mission-driven environment that values collaboration and integrity. Join us to make a meaningful impact in patients lives while building a rewarding career in a trusted Fortune 500 healthcare company.
How to Apply
Interested candidates are encouraged to apply through the CVS Health Careers Portal.
Submit your updated resume and active pharmacy technician certification along with a brief cover letter highlighting your experience in claims adjudication.
Apply now and become part of a team that helps millions of patients access the medications they need every day.
