Adjudication Associate – Overnight

CVS Health

. Prepare and submit claims for accounts to ensure timely reimbursements .

Posted 10/22/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $17 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims preparation and submission within a pharmacy-based setting, ensuring compliance with regulatory requirements while effectively managing denied claims and backlogs. Strong ability to communicate with healthcare professionals and maintain relationships to facilitate timely reimbursements.

Highest-signal resume keywords

Claims PreparationCustomer ServicePharmacy Technician CertificationMicrosoft ExcelManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims SubmissionRegulatory ComplianceIssue ResolutionData ResearchBacklog Management

Soft Skills

Team CollaborationIndependent WorkReliabilityEffective CommunicationMulti-tasking

Tools & Technologies

Microsoft AccessDesktop Software Applications

Certifications & Qualifications

Pharmacy Technician Certification

Industry Keywords

Managed CareMedicaidMedicarePharmacy-Based Setting

About the role

Key responsibilities & impact

Prepare and submit claims for accounts to ensure timely reimbursements
Communicate with nursing facility staff, physician offices, and insurance companies to maintain payment deliverables for online claim submissions
Execute routine business support tasks for the Adjudication Omnicare function under general supervision
Develop effective relationships with team members to resolve issues and prevent service delays
Review and research rejected claims and take action for resolution
Handle backlogs of denied claims for timely resubmission
Ensure compliance with government and regulatory requirements
Execute techniques, processes, and responsibilities under direction

Requirements

What you’ll need

At least 1 year of experience in a pharmacy-based setting
At least 1 year of experience in customer service
Basic proficiency with desktop software applications, particularly Microsoft Excel and Microsoft Access
Must be able to work Monday-Friday from 9:00pm-5:30am Eastern Standard Time
Willingness to work weekends once every three weeks and holidays several times per year
High school diploma or GED
Pharmacy technician certification preferred
Previous experience in managed care and Medicaid and/or Medicare organizations preferred
Ability to perform multiple tasks effectively
Ability to work both independently and as part of a team
Ability to operate independently
Dedicated and reliable nature

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility