Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

As a Manager, Client Services – Adjudication Solutions, you will act in the role of business lead/business owner for the team and across departments. In this role you will lead across departmental projects ensuring consistency in all project work and be responsible for facilitating, defining and documenting business requirements for strategic Pharmacy Client Solutions and Adjudication projects. The projects you lead will be geared toward operational efficiencies in adjudication claim processing as well as support of other operational applications that involve plan benefits builds and formulary management. You will be directly responsible for working with the information services department as key sign-off for all phases of the application development. You are responsible for project concept, business requirements, functional requirement sign-off, design sign-off, user acceptance testing, implementation and roll-out of new functionality.

 

You will accomplish this by:

Handling key projects with multiple challenging deadlines.Consulting with clients and internal partners, including executive leadership and subject matter experts.Facilitating internal and client stakeholder meetings and presentations to arrive at key decisions.Providing and working towards completion of project business requirements and documentation.

 

To be a candidate for this role, you will possess the following:

Well-developed management, written & oral communication, and presentation skills.Dynamic experience in a health care benefits services industry or a similar industry.Demonstrable skills planning, executing, and handling complex initiatives and functions.Ability to identify processes, functions, and procedures requiring improvement, then develop and execute appropriate solutions.

 

Required Qualifications

5+ years of experience and knowledge of all phases of IT System Development Lifecycle.Combined 5+ years of experience as an analyst/business owner driving requirements for Business or IT Projects.3+ years of RxClaim adjudication experience.

Preferred Qualifications

3+ years of providing functional specifications for system enhancements.Experience with Sales Force Case Management.Expertise and background in accumulations / prior authorization / Follow Me Logic functionality.Quality Assurance and/or User Acceptance Testing experience.

Education

A Bachelor's degree is required, equivalent work experience may be considered.

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/16/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.