CVS Health

Operations

• Perform rebate reconciliation activities, payment analysis, dispute resolution, reserve analysis, and related financial analyses
• Work closely with Trade Relations, Legal, Accounting, and pharmaceutical manufacturers
• Review and comprehend contract terms applicable to the Reconciliation function
• Track and apply payments due from pharmaceutical manufacturers
• Identify late payments and request late fee billing as required by contract
• Manipulate and analyze payment data from pharmaceutical manufacturers
• Reconcile payment data with invoiced amounts to identify disputed items
• Analyze and research variances and disputed items and determine whether to accept or reject disputes
• Communicate with pharmaceutical manufacturers regarding variances and disputes
• Update internal dispute tracking data monthly
• Perform required reserve analysis monthly
• Investigate and respond to inquiries regarding open balances
• Help reduce clients’ overall drug spend and make quality care more affordable and accessible

Financial Operations Analyst

Advocate

• Make inbound and outbound calls to members and providers regarding healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers preventing members from achieving good health
• Deliver an exceptional member experience through professional, empathetic conversations
• Educate members to support informed health decisions and improved health outcomes
• Accurately document conversations in members’ health records
• Help Medicare members understand and complete important health screenings and activities
• Explain benefits related to specific screenings and medications
• Assist members and providers with health services, medications, and resources
• Escalate issues for resolution when needed
• Meet business metrics and goals while working independently in a fast-paced environment

Health Advocate – Inbound/Outbound Calls

Salesforce Administrator

• Support the development and optimization of a 15-year-old Salesforce Org of moderate complexity with an extensive code base
• Execute day-to-day platform operations across the Salesforce environment
• Implement configuration enhancements
• Monitor platform technical health
• Support third-party application integrations
• Maintain a stable, scalable, and business-aligned platform
• Configure Salesforce Flow, assignment rules, approval processes, fields, page layouts, record types, dynamic layouts, apps, actions, custom settings, dashboards, and reports
• Deliver advanced UI/UX improvements
• Complete user support tickets
• Support org add-ons such as Marketo, Data Loader, and FormAssembly
• Manage users and licenses, including user setup/deactivation, roles, profiles, permissions, public groups, OWD, and sharing rules
• Support User Acceptance and Regression Testing
• Maintain data integrity and overall org health
• Stay current with Salesforce updates, best practices, and emerging trends
• Collaborate with administrators, business analysts, developers, and a solution architect

• Provide administrative and operational support for one or two large client accounts or a portfolio of smaller health plan clients
• Act as subject matter expert and operational owner for member journey processes and client collateral
• Guide clients through process requirements, implement updates, resolve inquiries, and track action items
• Own meeting documentation for client-facing calls and internal team syncs, including agendas, decks, minutes, and action items
• Capture, document, and track open items and deliverables from meetings and email correspondence
• Manage ad-hoc client inquiries by coordinating with internal departments and delivering timely responses
• Coordinate intake, internal routing, and client-facing resolution of member grievances
• Partner with Production, Business Analysts, and Data Relationship Managers to maintain operational workflows and account priorities
• Document and communicate client nuances in profiles, account records, and tracking sheets
• Provide backup coverage for Client Success Manager/Executive or Client Operations Owner
• Serve as primary account contact for smaller accounts or lines of business

Senior Client Operations Analyst

Consultant

• Review clinical information and apply evidence-based criteria to make coverage recommendations
• Collaborate with providers and interdisciplinary teams to support member care
• Identify opportunities to improve healthcare quality, outcomes, and benefit utilization
• Coordinate referrals to additional programs and services that support member needs
• Serve as a clinical resource for internal and external stakeholders
• Support Utilization Management operations in a fast-paced, collaborative environment
• Combine patient advocacy, care coordination, and healthcare decision support to help members receive appropriate care

Utilization Management Nurse Consultant

Manager

• Negotiate single case agreements for episodes of care on a pre-service basis
• Analyze forecast changes within the Contract Negotiations industry
• Develop business impact assessments and modification strategies using process improvement methodologies
• Recommend approaches to manage cost issues and support cost-saving initiatives and settlement activities
• Develop, maintain, and enhance relationships with physicians/providers and local network and patient management teams in Aetna markets
• Coach more junior colleagues in techniques, processes, and responsibilities
• Collaborate cross-functionally with internal teams to support and manage negotiations
• Construct, execute, review, and analyze contracts
• Deliver dispute resolution and settlement negotiations with providers
• Ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals

Provider Contract Negotiation Manager

Dietitian

• Provide one-on-one virtual coaching focused on nutrition, weight management, chronic disease prevention, and healthy lifestyle habits
• Develop personalized care plans and measurable wellness goals
• Motivate and support members in making sustainable behavior changes
• Document coaching sessions, progress, and outcomes
• Collaborate with interdisciplinary healthcare teams to deliver integrated care
• Stay current on nutrition science, coaching techniques, and best practices

Health Coach, Dietitian

Engineering Manager

• Lead, mentor, and grow a high-performing AI/ML and GenAI engineering team
• Set strategic technical direction and advocate for scalable architecture and responsible AI development
• Partner with business leaders and IT teams to translate requirements into technical roadmaps and solutions
• Oversee AI initiatives from ideation through production deployment and adoption
• Design and develop AI/ML and GenAI solutions
• Champion low-code/no-code platforms such as Microsoft Copilot Studio and Power Automate, alongside full-stack development
• Establish DevOps, CI/CD, and data governance practices
• Ensure compliance with architecture, security, privacy, audit, and enterprise governance standards
• Advise business and IT partners on AI adoption, use-case evaluation, and solutioning
• Build cross-functional relationships across engineering, business, and governance stakeholders
• Report program progress, risks, and delivered value to senior leadership

Senior Manager – Software Development Engineering

Platform Engineer

• Define, implement, and maintain key performance metrics, SLOs, and SLIs
• Align reliability metrics with business objectives and operational goals
• Manage error budgets and collaborate with development teams to balance reliability and feature delivery
• Analyze incidents and outages to inform error-budget adjustments
• Design and implement comprehensive monitoring solutions, dashboards, and alerts using Prometheus, Grafana, Loki, Tempo, and other observability platforms
• Architect, design, and implement scalable cloud infrastructure for multiple business applications
• Develop and implement automated quality gates for release reliability and performance standards
• Lead the release DevOps team in integrating quality gates into CI/CD pipelines
• Assist with incident response using metrics and monitoring insights
• Conduct post-mortem analyses, identify root causes, and recommend preventive measures
• Use AI to identify changes, anomalies, and next-best actions from metrics, logs, and traces
• Apply GenAI to accelerate incident triage and root-cause analysis
• Monitor AI workloads for quality, safety, cost, latency, and reliability with end-to-end tracing and secure logging/redaction
• Embed AI signal checks into CI/CD to identify SLO risk, latency/error drift, and regression patterns before production release
• Work closely with cross-functional teams to improve reliability, performance, and scalable growth of cloud-based systems

Staff Observability Platform Engineer – SRE

Analyst

• Support Medicare, Commercial, and Medicaid clients that delegate Prior Authorizations, Organization Determinations, Coverage Determinations and Appeals to CVS Caremark
• Ensure flawless audit performance
• Ensure health plan clients receive accurate, consistent, and timely documentation/files for audit-related activities
• Understand and apply CMS guidance and business requirements
• Complete assignments with urgency and meet set timelines
• Maintain professional internal communication with the Client Audit Team, Account Management Team, Reporting Teams, and other departments
• Apply attention to detail, verbal and written communication skills, and critical thinking

Analyst, Audit Support – CGSO

• Lead end-to-end contract negotiations, execution, and analysis with ancillary providers, physician groups, and smaller/local systems
• Manage contract performance and develop and implement value-based arrangements aligned with organizational strategy
• Identify, recruit, and onboard providers to meet network expansion and adequacy targets
• Deliver competitive and sustainable cost arrangements
• Partner cross-functionally on provider compensation strategy, pricing development, and reimbursement modeling
• Analyze financial and operational data to identify cost-saving opportunities and execute impactful initiatives
• Represent the organization with providers, customers, and community stakeholders
• Contribute to provider network strategy aligned with state requirements, product needs, and cost management objectives
• Optimize provider engagement and resolve escalations involving claims, contract interpretation, and provider data accuracy

Contract Negotiation Manager

• Execute routine and non-routine business support tasks for the Medical Claims area under limited supervision
• Follow area protocols, standards, and policies to provide effective and timely support
• Review provider billing practices to identify trends and cost savings opportunities
• Conduct training programs related to claim billing appropriateness and health plan guidelines for claim processors
• Test automated code review programs
• Execute techniques, processes, and responsibilities as directed
• Respond to customers on benefit inquiries
• Maintain customer service standards
• Administer policies and procedures for medical cost management
• Coordinate support functions for claim adjudication

Medical Claim Analyst

Nurse Practitioner

• Deliver remote patient care through a virtual technology platform
• Independently provide holistic, evidence-based assessment, diagnosis, treatment, health-problem management, health counseling, and disposition planning
• Provide pregnancy prevention, STI prevention, safer-sex, contraceptive-care counseling, and medication management
• Evaluate primary care, acute, chronically ill, and transitional-care patients aged 18 months and above
• Educate patients on health maintenance and respond to patient-care inquiries
• Document patient care in the EHR according to MinuteClinic policies and procedures
• Coordinate care with internal and external colleagues, including the broader patient-centered medical home
• Work within a patient-care team with Providers, Collaborative Physicians, paraprofessionals, Pharmacists, and other healthcare team members
• Work independently, prioritize and solve problems, take initiative, and advocate for patients and the practice

Virtual Care Nurse Practitioner – Contract

Implementation Specialist

• Direct all aspects of customer benefit plan implementation for self-funded new business clients
• Partner with key internal and external stakeholders to identify and address critical implementation issues
• Lead planning and execution of organizational projects aligned with goals, timelines, and budget constraints
• Develop project plans, team member assignments, deliverables, deadlines, and milestones
• Conduct project post-mortems and apply lessons learned to improve project management practices
• Implement and enforce quality control processes
• Develop change management plans and strategies to support successful adoption
• Identify project risks and issues, develop mitigation strategies, and establish contingency plans
• Prepare and deliver project progress reports
• Direct individuals managing multiple projects and competing priorities
• Coach junior colleagues in project management techniques, processes, and responsibilities

Senior Implementation Manager

Investigator

• Conduct high-level, complex analysis of dental providers and practices to prevent, investigate, and prosecute Fraud, Waste and Abuse
• Collaborate with Dental Network to provide evidence supporting corrective action
• Handle sensitive, high-profile, and nationally scoped cases
• Investigate to prevent payment of fraudulent activities
• Research and prepare cases for clinical, legal, and leadership review
• Document case activity in the case tracking system
• Make internal and external referrals within required timeframes
• Communicate and cooperate with federal, state, and local law enforcement agencies
• Provide expert testimony during civil and criminal proceedings
• Give presentations to internal and external customers regarding dental matters
• Provide input on controls for monitoring Fraud, Waste and Abuse issues
• Maintain open communication with internal and external constituents