CVS Health

Claim Specialist

• Review and adjudicate complex, sensitive, and specialized medical claims according to established plan processing guidelines
• Provide subject matter expertise, coaching, and guidance on escalated or technically challenging issues
• Support customer service operations by addressing inquiries and resolving issues
• Review pre-specified claims and claims exceeding specialist adjudication authority or processing expertise
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and implement cost-containment measures
• Ensure regulatory compliance and verify payments align with company policies and procedures
• Identify and report potential overpayments, underpayments, and other claim irregularities
• Perform claim rework calculations
• Train and mentor team members as needed
• Conduct outbound calls to obtain required information for claims or reconsideration requests

Senior Claim Benefit Specialist

Technical Product Manager

• Collaborate with business and technical partners to support HRSD functional areas and roadmap, including colleague portal and HR Knowledge Management
• Develop product vision, goals, and roadmap with business leaders and stakeholders
• Maintain deliverables and timelines, develop execution plans, and communicate progress
• Ensure delivered products meet or exceed business needs and objectives
• Deliver enhancements, project requests, and defect fixes using optimal and scalable solutions
• Gather requirements, optimize business processes, perform fit-gap analysis, functional design, configuration, and testing
• Maintain transparency, consistency in delivery, and stakeholder expectations with cross-functional partners
• Evaluate ServiceNow capabilities through research and testing
• Participate in ServiceNow’s semi-annual release process and coordinate cross-functional initiatives and impacts
• Engage with the ServiceNow Community on future releases and promote product innovation
• Analyze data and metrics to inform ServiceNow strategy and share insights and actions
• Advise partners on HR and Payroll business processes and operational issues
• Generate reports and analytics for business needs
• Provide strategic direction to product and shared services teams; mentor and develop team members
• Serve as ServiceNow HRSD subject matter expert for Employee Center, HR Service Delivery, Knowledge Management, case management, lifecycle events, journeys, and portal capabilities
• Drive HR knowledge strategy and quality across regions and HR domains
• Define and maintain standards for portal content, taxonomy, metadata, service catalog structure, audience targeting, approvals, ownership, and lifecycle management
• Own enterprise ServiceNow Knowledge Management design decisions for workflows, taxonomy, metadata, permissions, and lifecycle management
• Provide expert guidance and best practices for ServiceNow HRSD applications and business process optimization
• Lead data analysis and reporting to support decisions and identify platform improvement opportunities
• Stay current with ServiceNow industry trends and advancements
• Support user acceptance testing and maintain stakeholder communication

Senior Technical Product Manager – ServiceNow HRSD, Employee Center Pro

Systems Engineer

• Define and own enterprise data architecture strategy across operational, analytical, and AI/ML workloads
• Design and govern data models, data contracts, and canonical schemas
• Evaluate and standardize data platform tooling including data lakes, warehouses, streaming, and serving layers
• Serve as the primary subject matter expert for shared data platform concerns
• Lead technical design and solutioning for foundational data components
• Own data governance frameworks covering classification, lineage, ownership, and quality standards
• Partner with legal, security, and compliance teams on HIPAA, CCPA, and healthcare regulatory requirements
• Define and enforce data access controls, masking strategies, and PHI handling
• Drive data catalog adoption and metadata management
• Establish data retention, archival, and deletion standards
• Design architectures supporting AI/ML training, feature engineering, and inference pipelines
• Define feature store patterns and real-time data serving strategies
• Partner with AI engineering teams on LLM and generative AI data contracts and schemas
• Establish dataset versioning, training/serving skew detection, and model input monitoring patterns
• Advise product engineering, platform, and analytics teams on data architecture
• Create documentation, architecture decision records, and onboarding guides
• Drive alignment on data standards, naming conventions, and shared data product strategies
• Establish data quality frameworks, observability standards, alerting, lineage tracking, and incident response
• Drive data reliability engineering practices and pipeline testing

Staff Systems Engineer – Digital

Strategy

• Lead one or more Market Intelligence workstreams by defining scope, structuring plans, and adjusting course as priorities evolve
• Analyze market trends, competitive dynamics, macroeconomic factors, and growth opportunities to shape strategic recommendations
• Direct hypothesis-driven analysis and ensure insights are accurate, timely, and decision-ready
• Synthesize qualitative and quantitative insights into clear points of view
• Challenge assumptions, reconcile differing perspectives, and connect findings to broader strategic implications
• Craft executive-ready narratives, business cases, and recommendations from complex analysis
• Develop recurring competitive intelligence and rapid-response analyses for senior leaders
• Distill complex market and technology developments into concise insights, presentations, and market landscapes
• Build stakeholder relationships and facilitate discussions that drive alignment
• Partner with the Enterprise Strategy team to support growth opportunity identification, market assessment, M&A, and partnership evaluation
• Leverage AI-enabled research and market intelligence tools to inform enterprise decision-making
• Coach junior colleagues and build alignment across senior stakeholders

Senior Manager, Corporate Strategy

Engineering Manager

• Lead engineering teams building the consumer health experience on the Health100 platform
• Identify, prioritize, shape, and execute complex platform initiatives
• Design, oversee, and evolve scalable distributed systems, APIs, and AI-enabled platform capabilities
• Recruit, mentor, and retain high-performing engineers
• Foster innovation, continuous learning, and modern engineering and AI-assisted development practices
• Lead engineering initiatives from strategy and prioritization through delivery on complex, high-visibility projects
• Drive measurable business outcomes
• Establish KPIs and OKRs, proactively mitigate risks, and ensure operational excellence
• Promote secure, compliant, and responsible use of AI technologies
• Partner with engineering, product, design, security, analytics, and business teams
• Guide integration and validation of complex technology solutions
• Leverage Java, distributed systems, cloud platforms, Generative AI, machine learning, and intelligent automation

Senior Manager – Software Engineering, Health100 Platform

Scrum Master

• Lead Agile delivery for one or more ServiceNow teams by facilitating Scrum ceremonies, managing sprint execution, coordinating releases, and aligning work with product roadmaps and business priorities
• Partner with Product Owners, ServiceNow process owners, and stakeholders to refine and prioritize backlogs, translate epics and user stories into actionable work, establish sprint goals, and maintain delivery visibility
• Coach and mentor teams on Agile, Scrum, Kanban, and Lean principles
• Identify and remove delivery impediments, manage risks, dependencies, and RAID items, and use performance metrics to drive improvements
• Implement process enhancements that increase efficiency, quality, and predictability
• Serve as the primary communication and coordination point across development teams, engagement managers, stakeholders, and leadership
• Provide transparent status reporting, facilitate decision-making, support change management, and promote shared ownership of business value delivery
• Drive continuous improvement and help teams deliver high-quality ServiceNow solutions supporting enterprise business objectives

ServiceNow Scrum Master

Analyst

• Develop proactive and reactive leads to identify potential fraud, waste, and abuse
• Generate FWA leads by mining claims databases, reporting tools, and investigative systems
• Validate and refine business-rule-generated leads for credibility and investigative value
• Examine spike analyses, utilization trends, payment anomalies, and outlier reports
• Evaluate provider, member, pharmacy, DME, transportation, and facility billing for fraud or abuse indicators
• Monitor internal and external intelligence sources for emerging fraud schemes and patterns
• Perform quantitative and qualitative analysis of medical and pharmacy claims data
• Analyze CPT, HCPCS, ICD, DRG, NDC, modifier usage, and reimbursement trends
• Review provider billing history, peer comparisons, utilization metrics, and financial impact analyses
• Research internal systems, public records, licensing boards, sanctions lists, and other investigative resources
• Analyze relationships among providers, members, facilities, and associated entities for potential schemes or collusion
• Develop lead summaries outlining allegations, evidence, and risk indicators
• Present findings and recommendations to SIU leadership and investigative staff
• Determine whether findings warrant formal investigation, monitoring, or closure
• Document investigative rationale and evidence according to SIU policies and regulatory requirements
• Partner with investigators, clinicians, legal, compliance, and business partners
• Participate in fraud trend discussions and special projects
• Support improvements to business rules, data mining strategies, and lead generation methodologies
• Assist with training and knowledge related to emerging fraud schemes and healthcare billing practices
• Ensure compliance with CMS, state Medicaid regulations, Medicare requirements, organizational policies, and SIU procedures
• Maintain confidentiality and safeguard sensitive information
• Meet productivity, quality, and timeliness standards
• Support internal audits, quality reviews, and regulatory reporting activities

Lead Review Analyst, Special Investigation Unit

Pharmacist

• Support the pharmacy team in delivering operational and service excellence within the store
• Serve as an initial point of contact for patients and customers
• Follow company SOPs and pharmacy workflow procedures across production, pickup, drive-thru, and drop-off workstations
• Ensure prescriptions are filled promptly, safely, and accurately
• Provide compassionate patient service and resolve or escalate patient problems
• Offer immunizations and other patient health services at the register and over the phone, where permitted
• Complete inventory activities including medication deliveries, cycle counts, returns-to-stock, and waiting-bin inventories
• Maintain compliance with applicable laws, regulations, professional standards, ethical principles, and CVS policies
• Travel voluntarily to other stores in the market to work shifts as needed
• Complete required training and licensing or certification requirements
• Where permitted, support immunization activities including vaccine preparation and administration, patient education, adverse-reaction response, documentation, and vaccine-supply management
• Perform any additional tasks directed by a Supervisor or Manager

Pharmacy Technician

Full-stack Engineer

• Design, deliver, and operate business-critical distributed systems
• Build and sustain innovative software solutions
• Ship and operate large-scale systems using full-stack development
• Design, implement, and operate distributed systems at scale
• Collaborate as a key member of a technically strong, entrepreneurial team
• Transform healthcare through technology that supports value-based care and makes the home a health hub

Senior Software Development Engineer

• Develop and implement technical solutions for Dispensing Applications Technologies
• Analyze, design, code, test, debug, and document software applications supporting automated mail-order pharmacy operations
• Lead large-scale and complex application and process redesign/improvement initiatives
• Support and enhance integrated dispensing applications for filling, scanning, sorting, packing, inventory, postage, prescription intake, and reporting
• Apply best practices in system design, coding, testing, documentation, and project execution
• Research and resolve complex application issues
• Vet vendor quotes and deliverables
• Drive adherence to support agreements through vendor report cards
• Provide vendor performance feedback and communicate priorities
• Own automated dispensing team deliverables while collaborating with internal and outsourced teams

Software Development Engineer

• Perform complex medical economic projects, including contract rate modeling
• Identify and complete key deliverables to meet business objectives
• Develop and implement medical economics business efforts, including medical cost initiatives, policies/programs, budgets, and analytical models
• Partner with Network Management to analyze medical costs and assess contracted-rate effectiveness
• Create and implement plans to manage medical costs based on analysis and trends
• Develop market-specific provider reimbursement schedules
• Oversee standard and ad-hoc reports for risk assessment, budgeting, hospital chargemaster analysis, and forecasting
• Coordinate rate approvals and develop pricing for complex contractual arrangements
• Develop and communicate tactical and strategic plans to satisfy information needs across products, segments, and markets

Senior Analyst, Medical Economics

• Define product vision and strategic direction for the Epic Documents Domain
• Translate business goals into actionable product strategies tied to OKRs
• Define product roadmaps and manage day-to-day backlog prioritization
• Assess value, develop business cases, evaluate buy-versus-build opportunities, and identify scaling opportunities
• Coordinate with engineering, data science, and user design partners in an agile environment
• Manage dependencies, API transitions, and cross-cutting priorities with product management peers
• Conduct user research and document detailed product requirements
• Design intuitive products with the design team and ensure they meet user needs
• Manage product launches, training materials, and end-user documentation
• Identify product improvements through quantitative analysis and user feedback
• Deliver executive-level reporting on product status, risks, and decisions
• Develop testing procedures and governance for onsite, monthly, and quarterly Epic assessments
• Partner with training and change management teams on readiness, adoption, and feedback for Epic releases
• Support approval of product iterations, schedules, releases, and roadmaps
• Support recruiting, hiring, and development of product and informatics talent

Senior Technical Product Manager – Documents Domain

Financial Planning and Analysis

• Support the Aetna Business Operations consolidated reporting team
• Consolidate financials
• Create management presentations and/or talking points for month close, forecast, budget and multi-year strategic plan
• Drive standardization across the organization
• Collaborate with Aetna Business Operations finance teams to ensure reporting is accurate and timely
• Identify the key drivers behind financial results
• Coordinate planning and analysis of projects of varying nature and complexity
• Support special projects and perform ad-hoc analyses
• Drive continuous process improvement and leverage technology

Manager, FP&A

General

• Lead overall retail store operations across an assigned district, including Front Store and Pharmacy
• Develop and execute district business plans and strategies covering P&L, sales and script budgets, inventory, payroll, asset protection and shrink
• Analyze competitive landscape and business trends to identify opportunities
• Align front store and pharmacy teams on programs, services and execution expectations
• Deliver healthcare outcomes and initiatives
• Communicate district plans and resolve store-related issues
• Create and lead a district culture delivering a differentiated customer experience
• Ensure compliance with federal, state and local pharmacy laws and regulations
• Execute community responsibility activities
• Develop and execute the district talent plan
• Promote colleague growth and engagement
• Ensure consistent execution of colleague training and development programs
• Manage succession plans and develop Store and Pharmacy Managers, Staff Pharmacists and interns
• Build a talent pipeline and ensure district staffing plans
• Provide market input for acquisition and real estate strategy
• Implement real estate strategy and support acquisitions
• Identify file buy and acquisition leads, cultivate competitor relationships and retain file buy assets
• Execute new programs and services across front store and pharmacy

District Leader

Revenue Operations

• Define product vision and strategic direction for the Epic domain
• Translate business goals into actionable product strategies tied to OKRs
• Define product roadmaps, manage and prioritize backlogs, and assess business cases
• Evaluate buy-versus-build opportunities and product scaling across business units
• Coordinate with engineering, data science, and user design teams in an agile environment
• Conduct user research and document detailed product requirements
• Design intuitive products and ensure they meet user needs
• Manage product launches, training materials, and end-user documentation
• Identify product improvements through quantitative analysis and user feedback
• Deliver executive-level reporting on product status, risks, and required decisions
• Develop testing procedures and governance for Epic assessments and documentation reviews
• Partner with training and change management teams to support readiness, adoption, and feedback
• Support approval of product iterations, schedules, releases, and roadmaps
• Support recruiting, hiring, and development of product and informatics talent