We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven
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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care. Key Responsibilities Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care. Member Outreach: Utilize all available resources to connect with and engage “hard-to-reach” members. Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs. Documentation: Maintain meticulous documentation of care management activities in the member’s electronic health record. Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable h
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary CVS Health is seeking a Senior Varicent Integration & Platform Engineer with expertise in technical architecture and integration to join the Human Resources Technology team. This experienced and motivated professional will support Compensation business operations by delivering optimal, scalable technology solutions. As an integral member of the team responsible for the Varicent Sales Performance Management (SPM) platform, its integrations, and its technical architecture, this role will address the needs of Total Rewards and Human Resources business partners and stakeholders. The ideal candidate will combine deep technical and platform expertise with a demonstrated ability to collaborate with technical and non-technical partners. The role will provide essential support to the Compensation organization for sales incentive technology needs and will collaborate with HR Technology, Centers of Excellence (COEs), and HR Shared Services across all business segments. This individual will establish cross-functional relationships throughout HR Technology and Human Resources to ensure that solutions and initiatives are effectively designed and implemented, with colleague satisfaction as a key goal. Primary Responsibilities: Collaborate with business and technical partners to support the Varicent technical architecture and integration roadmap, including the e
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once
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