CVS Health Medicare Pharmacy Claims Auditor in Scottsdale, Arizona

Job Description

This position is an exciting opportunity to join a specialized team of auditors as part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned Medicare Part D Compliance Audit Programs, review pharmacy submitted Medicare claims, make independent decisions, and call network pharmacies to audit submitted information and communicate business requirements. Candidates will work as part of a specialized team of auditors, working together to successfully complete audit projects. Candidates must be highly motivated, possess strong communication skills, effective time management skills, and be very detail-oriented. Candidates will become an expert on the CVS Health Medicare Audit Programs and will own one or more of those audit program processes on an ongoing basis. Candidates must possess extremely strong teamwork and collaboration skills and be skilled in sharing common workloads with peers. Candidates will have expansive opportunities to innovate and develop new tools to enhance the execution of audit programs, and work with internal and external partners to develop successful solutions within the scope of the processes for which they are accountable.

Daily tasks may include:

  • Telephone outreaches to network pharmacies to verify claim information

  • Transmission of audit requests to pharmacies

  • Review of hard copy prescriptions to verify compliance with CMS requirements and CVS Health contractual requirements

  • Review of incoming documentation from pharmacies and input information into internal CVS Health audit systems

  • Corresponding with network pharmacies to answer questions regarding Medicare Audit Programs Monitor assigned audit processes and report status on a regular basis

  • Meeting with internal partners to develop and communicate business objectives

  • This role will work closely with internal and external partners to conduct audits which help keep CVS Health plans in compliance with CMS requirements and maintain positive STAR ratings

Required Qualifications

-1+ year(s) combined experience in a PBM or pharmacy

Preferred Qualifications

  • 5+ years combined experience in a PBM or pharmacy

  • 2+ year(s) experience in pharmacy or PBM claim processing systems

  • Spanish language fluency preferred

  • Familiarity with current CMS Medicare Part D compliance regulations

  • Advanced level of technical skillsets including Microsoft Excel, Microsoft Access, SQL databases

  • Team player and collaborative attitude

  • PTCB licensure

  • Completion of Medicare D Technician training


Verifiable High School Diploma or GED required. Bachelor's Degree preferred.

Business Overview

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at and EEO IS THE LAW SUPPLEMENT at

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel at mailto:Advice&

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: