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
Designs enterprise-wide and/or cross-functional solutions to address business problems. This work results in initiatives that significantly impact organizational strategy, enabling the organization to be competitive in the marketplace and effectively serve its customers. Partners with business owners to optimize the achievement of strategic business objectives, to include profitable growth and improved organizational effectiveness.
What you will do
Advises management through strategic business consultation to support the organization's goals and objectives.
Develops standard procedures related to researching, collecting, analyzing, and compiling data and information for business consulting department reports.
Develops and implements processes for auditing files, reports, and financial records ensuring compliance with relevant laws and regulations.
Communicates with top management to lead individuals to develop a high degree of customer service by fielding internal and external inquiries, finding resolutions, or redirecting as appropriate.
Communicates strategically internally and externally with clients and senior management regarding the organization's goals and objectives.
Counsels the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management.
Advises management regarding current business trends and best practices preparing analysis for senior management, stakeholders, and clients.
Controls all systems for performance appraisals within the business consulting department ensuring compliance and continuous improvement.
Evaluates performance through regular, timely feedback to ensure delivery of exceptional services and engagement, motivation, and team development.
Required Qualifications
10+ years work experience in Healthcare Insurance Operations
Mastery of problem solving and decision making skills
Mastery of collaboration and teamwork
Mastery of execution and delivery (planning, delivering, and supporting) skills
Strong SQL Development Skills, Report Development Skills in Power BI and Tableau
Ability to bridge communication gaps between business and IT partners.
Preferred Qualifications
WEDI X12/837I/837P EDI Gateway Processing, Editing and Mapping
Clean Claim Edits
Medicaid Risk Adjustment Strategy
Process Flow and Project Management
Education
4 year degree or equivalent business experience
Pay Range
The typical pay range for this role is:
$100,000.00 - $231,540.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 10+ years work experience in Healthcare Insurance Operations
- Strong SQL Development Skills
- Report Development Skills in Power BI and Tableau
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
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Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
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Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. 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. And we do it all with heart, each and every day.
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