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CVS Health Senior Claims Consultant in Northbrook, Illinois

Job Description

This position reports directly to the Sr Manager, Claims Adjustment team. The person will be a SME in RxClaim adjudication and reprocessing, AS400 data extracts and analysis and other applications used by the team. You will be responsible for processing RxClaim R&R batches, RxClaim engine management, ERIC batch release, and other adjustment related activity. You will also act as the liaison between the business and IT and represent claim adjustment processing on new projects or other development activity. You will represent the claims adjustment team on various projects and may be asked to work on key strategic projects. You may be required to perform analysis and work directly with internal and external clients. Hours will be from 7 AM EST to 3 PM ESTPosition is fully remote.

Required Qualifications

5+ Years of experience with RxClaim adjudication and processing/reprocessing. Individual must possess excellent communication skills (both verbal and written). Ability to take complex issues and present them in a clear and concise manner. Project management and leadership skills are also required.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Candidates that have CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or other relevant experience are highly desired. PBM Operations, Medicare Part D, Customer Care Operations, or other key business areas strongly desired. The candidate must be able to demonstrate their ability to successfully handle multiple complex issues in a fast paced and changing environment.The ideal candidate will also have experience with mainframe processing and data pulls, adjudication and financial systems, and other CVS Caremark applications.


BA/BS in Financial systems, Accounting systems, Business, or Information Systems required.

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.