Senior Manager, Payment Integrity COE

CVS Health Careers

. Provide centralized program leadership for intake, tracking, coordination, reporting, and resolution of rework and escalations across the Payment Integrity Center of Excellence .

Posted 11/3/2026full-timeHartford • Connecticut • United StatesSenior💰 $75,400 - $199,144 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in program and project management, with a strong focus on process improvement, data analysis, and stakeholder communication. Proficient in leading cross-functional initiatives and utilizing performance metrics to drive decision-making and operational efficiency.

Highest-signal resume keywords

Program ManagementProcess ImprovementData AnalysisStakeholder CommunicationHealthcare Payment Integrity

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Project ManagementRoot-Cause AnalysisRework ReductionOperational GovernanceContinuous Improvement

Soft Skills

Excellent Written CommunicationVerbal FacilitationOrganizational SkillsPresentation SkillsInfluencing Without Authority

Tools & Technologies

Microsoft ExcelPowerPointWordTeamsSharePointPower BIVisioPlanner

Certifications & Qualifications

CPCCCSCPMACFEAHFIPMPLean Six Sigma

Industry Keywords

Healthcare ClaimsPayment IntegrityProvider ReimbursementAuditRecovery

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Provide centralized program leadership for intake, tracking, coordination, reporting, and resolution of rework and escalations across the Payment Integrity Center of Excellence
Own the centralized portfolio of Payment Integrity rework items and escalations, including intake, categorization, prioritization, status management, aging, dependencies, risks, decisions, and closure evidence
Maintain a consistent source of truth with defined owners, target dates, statuses, next steps, and escalation paths
Coordinate concurrent workstreams, follow up on commitments, remove barriers, and prevent unresolved items from becoming operational risks
Establish criteria and working norms for intake, triage, prioritization, handoffs, escalation, closure, and post-implementation monitoring
Lead structured working sessions with business and technical partners to clarify issues, scope, impact, root cause, controls, corrective actions, and decisions
Connect stakeholders across functions, vendors, systems, and processes to resolve complex issues
Identify stalled work, conflicting priorities, unclear ownership, resource constraints, and unresolved dependencies; elevate decisions with options and recommendations
Develop dashboards, scorecards, portfolio summaries, aging reports, risk views, and leadership updates
Define and track performance measures including intake volume, backlog, aging, cycle time, on-time actions, closure rate, recurrence, and financial or operational impact
Synthesize updates into decision-ready reporting highlighting progress, trends, exceptions, risks, decisions, and accountable owners
Document root causes, contributing factors, failure points, and control gaps
Track corrective and preventive actions through implementation, validation, and sustained closure
Analyze rework and escalation patterns to identify systemic issues, handoff friction, standardization, and automation opportunities
Design and facilitate governance cadences with agendas, pre-reads, decisions, actions, and follow-up
Maintain decision logs, action registers, risk and issue logs, milestone plans, and escalation records
Develop standard templates, definitions, workflows, and job aids
Prepare executive summaries, briefing materials, talking points, and recommendations
Coordinate communication, stakeholder alignment, documentation, training, and transition support for process changes
Lead, coach, and develop assigned employees or contractors supporting tracking, analysis, reporting, or coordination

Requirements

What you’ll need

7-10 years of progressive experience in program, project management, process improvement, audit, provider reimbursement, analytics
Experience coordinating complex, cross-functional initiatives with multiple owners, dependencies, and competing priorities
Ability to build and maintain trackers, action plans, dashboards, scorecards, executive summaries, and governance materials
Experience using data to identify trends, explain portfolio health, surface risk, and support prioritization and decision making
Excellent written, verbal, facilitation, organization, and presentation skills
Ability to establish structure in ambiguous situations, work independently, follow through on commitments, and appropriately escalate barriers
Ability to influence without direct authority and build productive relationships in a matrixed organization
Working knowledge of healthcare claims, payment integrity, reimbursement, audit, recovery, or related operational processes
Experience with Commercial, Medicare, Medicaid, Marketplace, or other healthcare payment models
Experience leading rework reduction, escalation management, root-cause analysis, corrective-action, operational governance, or continuous-improvement programs
Advanced proficiency with Microsoft Excel, PowerPoint, Word, Teams, and SharePoint; experience with Power BI, Visio, Planner, or comparable workflow and reporting tools
Experience coordinating vendor-related issues, service-level performance, implementation risks, or cross-enterprise handoffs
Knowledge of Lean, Six Sigma, SIPOC, RACI, ADKAR, Agile, or other structured process, change, and project-management practices
Professional certification such as CPC, CCS, CPMA, CFE, AHFI, PMP, Lean Six Sigma, or a related credential
Bachelor's degree or equivalent combination of education and relevant experience

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
CVS Health bonus, commission or short-term incentive program
Equity award program