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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Overview:Aetna, CVS Health is looking for top sales leadership talent! We have an exciting work from home opportunity available for highly motivated individual to manage our Telesales vendor relationships as a Lead Director of Sales Support. The position will lead a team who will manage our Telesales vendor relations. The role will be responsible in ensuring our vendors have a formalized approach on recruitment, training, quality, and managing of the call center staff and activities to achieve superior business performance and sales goals. This role is ideal for candidates that are energetic, empathetic, and looking to become part of a growing business segment. Job Responsibilities:<ul> <li>Manage and lead a sales organization with a high level of focus on selling Aetna’s Medicare products.</li> <li>Oversee and lead daily operations of the call center including, but not limited to, communications, performance management, program and product training.</li> <li>Responsible for executing Telesales operations to scale and grow business across all product lines.</li> <li>Maximize effectiveness and efficiency of the sales leadership and programs (i.e. sales volume) leveraging capacity and productivity, among other levers, to achieve target sales volume.</li> <li>Partner with other functions (ex. Sales operations, training, quality) to ensure that call center staff and operations are well trained and prepared for effective and efficient operations of the team.</li> <li>Deploy daily operating models for team to ensure effective sales operations, high quality program submissions, and achievement of business results.</li> <li>Develop enhanced sales techniques and drives sales through robust knowledge and experience and make improvements to the model.</li> <li>Designs the allocation of resources to support key performance metrics.</li> <li>Controls negotiations with clients in complex financial situations.</li> <li>Other duties as assigned.</li> </ul> Background/Experience desired:At least 5 years in sales leadership role(s) preferably in Telesales and/or Medicare programs.5+ years of managing individual contributors and managers.Demonstrated successful experience in developing internal Telesales capabilities for insurance companies.Superior knowledge of Medicare products desirable.Life &amp; Health insurance license is a plus but not required to be employed. It is required to obtain the license within 60 days from the employment start date.High level of proficiency with Microsoft Office package.Adept at collaboration and teamworkMastery of problem solving and decision-making skillsMastery of growth mindset (agility and developing yourself and others) skillsEducation:The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSInsurance/Licensed Life &amp; Health Insurance Agent (GA) is desiredPay RangeThe 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/08/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Lead Director Sales - Medicare

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.A Brief OverviewWe are looking for a distinctive candidate to aid in the development of our Supplemental Health product solutions, lead the development of product strategy and product marketing and messaging, assist in the evaluation of supplemental health market analysis and participate in driving new product and service development. As part of the Supplemental Health Product team, a successful candidate will need to be resourceful, leverage available internal and external information, manage initiative timelines, and build/maintain strong working relationships across the organization. A successful candidate must be able to provides expertise and thought leadership, contributing to strategic planning, aid in market research, help to drive profitable sales and revenue growth, deliver product and service innovation, help to drive cross-functional collaboration and ensure regulatory compliance. While part of a broader team, the candidate must be able to act independently in a fast-moving environment, where you will be aiding in the making of informed strategic and tactical decisions which will guide the organization's growth and success.Position Summary/What you will do<ul> <li>Act as a subject matter expert on Aetna Supplemental Health products and services and convey information clearly to diverse internal and external audiences.</li> <li>Leads and oversees product marketing efforts including the development and positioning of Supplemental Health value proposition.</li> <li>Collaborates on Supplemental Health Product development (for both product design and services), requirements, specifications, and roadmaps, working closely with stakeholders to create clear product/service vision and achievable goals.</li> <li>Assesses market trends, customer needs, and the competitive landscape to inform product strategy and drive the development of innovative and competitive products.</li> <li>Works cross functionally to manage multiple initiatives including timelines, risks, contingency plans and deliverables.</li> <li>Collaborates across business partners, including incorporating feedback from our clients and members, to evolve provider navigation, product strategy, and associated roadmap.</li> <li>Assists in the management of product portfolios, including planning, prioritization, and resource allocation to ensure timely and effective product delivery.</li> <li>Provides support for Requests for Information (RFI) and Requests for Proposal (RFP) during peak times.</li> <li>Provides additional compliance support for Supplemental Health products</li> </ul>Required Qualifications<ul> <li>Minimum 4+ years of voluntary, worksite industry, and/or insurance industry</li> <li>Voluntary/Supplemental Health experience and product knowledge (Accident, Critical illness, and Hospital Indemnity)</li> <li>Marketing/Communications skills</li> <li>Experience leading cross functional project management initiatives.</li> <li>Advanced communication/presentation skills</li> <li>Ability to adapt to ongoing change, think outside of the box and be truly distinctive.</li> <li>Adept at problem solving and decision-making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> </ul>Preferred Qualifications<ul> <li>Understanding of the Supplemental Health/Voluntary regulatory environment.</li> <li>Adept at growth mindset (agility and developing yourself and others) skills</li> </ul>Education<ul><li>Bachelor's degree preferred/specialized training/relevant professional qualification</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Supplemental Health Product Management and Development, Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Manager, Assumptions GovernancePosition Summary:As Manager, Assumptions Governance, you will be responsible for key support functions for CVS Health’s PBM assumptions management. This role is critical in ensuring PBM forecasting accuracy by supporting the underwriting and finance forecasting process as well as assisting with other financial processes. Primary responsibilities include understanding, assessing, and implementing financial and utilization assumptions and artifacts; leveraging a combination of data driven insights and market dynamics to validate and vet assumptions; leverage market leading tools for the CFAO &amp; PBM Finance organizations to review and maintain assumptions and artifacts; and communicating to business partners.Additionally, this position will:<ul> <li>Manage assumptions across the PBM organization including finance, supply chain and other key areas. Partner with Business resources to gather, refine and evaluate assumptions and artifacts to impact the Underwriting process.</li> <li>Foster strong links to the PBM finance team regarding forecasting assumptions, client profitability efforts, and financial governance of underwriting activities.</li> <li>Support discussions that are highly complex financially. </li> <li>Play a critical role in creating a pricing governance structure to ensure financial objectives and process excellence are both met while meeting challenging deadlines and expectations driven by the marketplace.</li> <li>Prioritize effectively and efficiently to meet internal and external customer needs.</li> <li>Respond to inquiries involving assumptions to ensure accuracy and precision.</li> <li>Support the presentation of information to Executive Leadership. Respond to questions in real-time in support of their review and approval.</li> <li>Participate in peer reviews of high complex data requests to validate that modeled data and related analytic deliverables match and satisfy business requirements.</li> <li>Assist in ad-hoc analysis. </li> </ul>The successful candidate will have a track record that demonstrates the following abilities: working successfully in a cross-matrix environment, adapting and performing in a dynamic and changing environment, developing and leveraging a comprehensive understanding of CVS Caremark’s enterprise assets, developing a deep understanding of internal and external assumptions, maintaining high levels of customer satisfaction, constantly striving to innovate and improve processes and applying financial and analytical expertise to make informed recommendations and decisions.Required Qualifications:<ul><li>5+ years professional experience process and change management, Financial modeling, financial analysis and/or program management.</li></ul>Preferred Qualifications: <ul> <li>Strong understanding of PBM or healthcare industry</li> <li>Experience working within matrix organization collaborating to create meaningful predictive analytics.</li> <li>Strong understanding of, or experience with, internal and external facing pricing and analytics teams.</li> <li>Ability to innovate, develop, and implement new products or solutions requiring collaboration with internal partners. Demonstrated success developing effective relationships with key internal partners across the enterprise.</li> <li>Working knowledge of relational databases and warehouses; SQL, Python or other reporting languages.</li> <li>Experience managing complex projects in a matrix environment.</li> <li>Ability to summarize complex financial analysis and support recommendations in presentations to Executive Leadership.</li> <li>Ability to work independently in a fast-paced environment and manage tight deadlines.</li> <li>Proficient in SQL and Microsoft Office.</li> </ul>Education:<ul><li>Bachelors Degree in a relevant discipline, such as finance, mathematics, business or other related field required or equivalent work experience.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager, Assumptions Governance

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.How will this role have an impact?The Executive Assistant will support technology executives in their day-to-day schedule management, meeting preparation, expenses, and a number of ad hoc work-related projects. This person will be the gatekeeper for the VPs and will help them prioritize and communicate with internal and external stakeholders in a timely, professional manner.What will you do?<ul> <li>Supporting technology executives in day-to-day activities including the coordination and management of meetings and daily schedule.</li> <li>Coordinate meetings, including booking rooms, and preparation of materials</li> <li>Manage expenses and submit expense reports in Concur</li> <li>Coordinate travel arrangements</li> <li>Assist with team events across multiple sites</li> <li>Arrange and execute team building, offsites, and social events/lunches</li> <li>Liaise with Technology and facilities departments regarding software, equipment, and office needs</li> <li>Ad hoc projects as needed</li> </ul>We are looking for someone with:<ul> <li>3+ years of experience in a supporting role for c-level executive</li> <li>Experience using G-Suite</li> <li>Proven professional organizational and time management skills</li> <li>Excellent interpersonal skills</li> <li>Track record of problem solving and critical thinking</li> </ul>Education<ul><li>Bachelor's degree preferred/specialized training/relevant professional qualification.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$22.59 - $58.85This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Executive Assistant - Technology and AI

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryWe are seeking an experienced medical professional to manage strategic initiatives, along with a team of medical coders/nurses supporting Aetna’s Special Investigations Unit.Key Responsibilities:<ul><li>Leadership: Leads a team of coding/nursing professionals who conduct reviews of medical records and claims for suspected healthcare fraud, waste, and abuse. Provides direction and counsel to support coders and progress reviews. Identification and implementation of key initiatives that support effective and efficient scalability along with meeting or exceeding ROI.</li></ul><ul><li>Team Management: Conducts team member evaluations and provides performance feedback to staff. Manages team’s caseload to ensure equitable distribution and exposure to wide range of reviews. Assist with business opportunities aligned to inventory allocation and prioritization.</li></ul><ul><li>Quality Control and Compliance: Maintains oversight of coder/nurse reviews, ensuring compliance with ICD-10, CPT and HCPCS coding guidelines. Assist with department build and implementation of SIU coding quality program.</li></ul><ul><li>Training: Assesses team’s training needs and works with SIU leadership on development plans for team members and SIU coding department. Contributes to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates. Coordinates ongoing trainings to educate team on updates or modifications to medical codes.</li></ul><ul><li>Presentations: Supports the team of coding/nursing professionals in presenting findings to internal and external stakeholders, including, but not limited to SIU Investigators, Aetna Plan Leadership, Law Enforcement, Legal Counsel, Providers, and State Regulators.</li></ul><ul><li>Collaboration: Develops and maintains close working relationships with Aetna Medical Directors, Nurses, and other clinical staff who conduct medical record reviews. Consults with clinical staff as needed to assist in reviews. Partnership with SIU leadership to deliver key initiatives dedicated to infrastructure build and stabilization.</li></ul>Required Qualifications and Skills:<ul> <li>Minimum of 8 years of experience in medical coding in an SIU setting with at least 5 years in a supervisory or management role.</li> <li>Strong knowledge of industry coding guidelines involving ICD-10, CPT and HCPCS codes.</li> <li>Ability to guide a team of coding professionals with differing levels of coding experience in a variety of medical specialties.</li> <li>Proficiency in Microsoft products including, but not limited to Word, Excel, Outlook, and PowerPoint.</li> <li>Experience in infrastructure build and design to include, but not limited to workforce modeling, efficiency identification and implementation resulting in demonstrated decrease in unit cost, inventory reporting, inventory allocation for Medicare, Medicaid and Commercial (fully insured and ASO) work product, development of standardized coding language, assist with operational dashboard development and execution of department action plans.</li> <li>Understanding of how to implement SIU coding quality programs, to include statistical sampling, IRR testing, building objective comprehension assessments for coding training and coding quality remediation plans.</li> <li>Ability to communicate to a wide range of stakeholders, adjusting the message as appropriate for the recipient(s).</li> <li>Proven experience in overseeing and executing operational projects.</li> <li>Potential to travel up to 10%, (dependent on business needs).</li> </ul>Preferred Qualifications:<ul> <li>Active Registered Nurse (RN) Licensure preferred</li> <li>Experience conducting audits of medical records to substantiate allegations of healthcare fraud, waste, and abuse.</li> <li>Experience leading a team of coding professionals who conduct reviews to substantiate allegations of healthcare fraud, waste, and abuse.</li> <li>Experience with Aetna or other MCO Commercial/Medicaid/Medicare plans</li> <li>Certified Professional Coder</li> </ul>Education:<ul><li>Bachelor's degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Special Investigations Coding Manager (Aetna SIU)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary The Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data. • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; •Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.(*) • Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) • When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) • Interprets and translates client benefits and supporting account structure against internal systems/applications(i.e.,GEBAR, AAS, and CCI). (*) • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. • Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients. Required Qualifications <ul> <li>Attention to detail and accuracy.</li> <li>Problem solving skills.</li> <li>Strong organization skills.</li> <li>Understands the impact of work to other teams and downstream support areas.</li> <li>Ability to analyze and research data to make appropriate corrections as necessary.</li> <li>Strong verbal and written communication skills.</li> <li>Workplace flexibility - ability to adapt to change.</li> <li>Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).</li> <li>Ability to remain available for overtime, with possible weekend work where needed.</li> </ul> Preferred Qualifications <ul> <li>Knowledge of Health Care and/or MCO’s.</li> <li>Knowledge of Enrollment.</li> <li>Knowledge Medicaid and/or Medicare.</li> <li>Knowledge and comfortability with learning different systems and using Excel (VLOOKUP).</li> </ul> Education <ul><li>High School Diploma or equivalent.</li></ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $28.46This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Eligibility Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Company: Oak Street Health Title: Sr Analyst,Prod Serv/SupptLocation: RemoteRole Description: As a Sr Analyst, Production Services/Support, your job will be to act as a bridge between the engineering and operations teams during production incidents, Change management, and problem management. You will collaborate with application owners, varying levels of management, and other team members to plan and implement Incident, Problem, and Change management related process improvements, report service management metrics, and serve as a liaison to software vendors and various IT staff for multiple applications and their infrastructure.This role requires on-call availability during evenings, overnight hours, and weekends on a rotating schedule.Core Responsibilities:<ul> <li>Serve as the first responder for major production issues for the Production Management support team.</li> <li>Lead major incident bridges, guiding resolver teams to achieve incident resolution within SLAs.</li> <li>Continuously assess business impact and communicate effectively across various groups and channels, including executive management.</li> <li>Engage necessary resources, including technical, product, and vendor personnel.</li> <li>Provide timely and accurate communication to all affected parties, including executive management.</li> <li>Maintain accurate incident and problem records in ticketing systems (e.g., JIRA, ServiceNow).</li> <li>Document incident timelines and remediation actions.</li> <li>Join forces with problem management in Root Cause Analysis (RCA), corrective actions through closure and proactive problem management.</li> <li>Prepare and present metrics, status and service health reports.</li> <li>Conduct training and knowledge-sharing sessions for various teams and new hires to support standardized processes.</li> <li>Drive the continuous improvement of service management processes and procedures to maintain high service quality.</li> <li>Regularly provide input and status updates for project tracking activities.</li> <li>Maintain the repository of troubleshooting documentation (Run book, Job Aids, Scripts, and Standard Operating procedures)</li> <li>Provide on-call support during non-business hours (team provides 24x7 support for incidents)</li> <li>Write scripts and automate as much of the production support as possible.</li> <li>Other duties as assigned</li> </ul>What are we looking for?<ul> <li>3 years of Production support experience and relevant experience in Service Now, DevOps, TechOps, Monitoring tools, and Process Improvements</li> <li>Preferred ITIL certification</li> <li>Ability to do complex, in-depth analysis and develop innovative methods to accelerate resolution with systems comprising custom developed products, SaaS, and other platforms.</li> <li>Advanced verbal and written communication skills necessary to present/explain technical knowledge, and provide advice to management, regulators, reviewers, and stakeholders.</li> <li>Experience and skills needed for customer support to include a focus on listening, rapport-building, clear communication, friendly and approachable nature, and courtesy and respect.</li> <li>They must possess an operations-oriented mindset and a knack for technical firefighting, diagnostics, troubleshooting and problem solving.</li> <li>Experience with ticketing systems (e.g. ServiceNow, Jira Service Management) is strongly preferred</li> <li>US work authorization.</li> <li>Someone who embodies being "Oaky".</li> </ul> What does being "Oaky" look like?<ul> <li>Radiating positive energy</li> <li>Assuming good intentions</li> <li>Creating an unmatched patient experience</li> <li>Driving clinical excellence</li> <li>Taking ownership and delivering results</li> <li>Being relentlessly determined</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Analyst,Prod Serv/Suppt (Major Incident Management)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryManage the development, submission, and state approval process for insurance form filings. Key Responsibilities:<ul><li>Drafting and reviewing product filings:</li></ul>Draft Medicare Supplement and short-term limited duration health insurance products (policies, forms, brochures, etc.) to ensure compliance with all applicable laws, regulations, and guidelines.<ul><li>Compliance:</li></ul>Verify that the products meet specific requirements regarding benefits, premium structures, eligibility, and other relevant aspects.<ul><li>Regulatory Updates:</li></ul>Stay abreast of changes in state and federal regulations related to Medicare supplement insurance.<ul><li>Record Keeping:</li></ul>Maintain accurate records of product filings and related correspondence.<ul><li>Coordination:</li></ul>Collaborate with other business areas and stakeholders within the company throughout the product filing and approval process.<ul><li>Specialized Knowledge:</li></ul>Possess a strong understanding of Medicare supplement and short term, limited duration health insurance products including and their benefits. Required Qualifications<ul> <li>Minimum of five (5) years of work experience in insurance product development and a policy forms drafting capacity with a health insurance carrier.</li> <li>Minimum of five (5) years of work experience with, health insurance products, specifically including Medicare Supplement and short-term limited duration health insurance plans, products, applicable regulations, and industry practices.</li> <li>Familiarity with legal research and review of applicable statutes and regulations.</li> <li>Strong analytical skills with the ability to review and analyze complex data and documents.</li> <li>Experience with independently drafting complex health insurance policy documents, applications, policy riders, and outlines of coverage.</li> <li>Strong attention to detail, in particular accuracy and meticulousness in reviewing and processing filings via SERFF.</li> <li>Excellent ability to communicate effectively, both verbally and in writing to effectively coordinate and communicate with internal business partners and insurance departments.</li> <li>Problem-Solving Skills: Ability to identify and resolve issues related to product filings.</li> <li>Software Proficiency: Proficiency in relevant software and databases such as Microsoft Word, Microsoft Teams, Adobe, PowerPoint, and Workfront. </li> <li>Experience with responding to insurance department questions and objections in response to insurance product filings.</li> <li>Extensive knowledge of insurance department rules and regulations governing coverage forms, endorsements, rules, and policy language requirements.</li> <li>Maintains a high level of confidentiality and professional demeanor and approach in the performance of duties.</li> <li>Must possess initiative to work independently without frequent supervisory involvement.</li> <li>Ability to quickly understand new insurance products and product changes.</li> <li>Possess high organizational skills and ability to set and adjust priorities.</li> <li>Ability to make decisions within scope of authority.</li> </ul>Preferred Qualifications Education High School diplomaAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analyst, Product & Regulatory Approvals

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryAetna, a CVS Health company has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy &amp; Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: ◾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. ◾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.◾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. ◾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. ◾Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. ◾Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Policy & Operations)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Must live in Central or Eastern Time Zone Training Schedule: Mon - Fri 9am-530pm EST Post Training Schedule: Must be available to work 8 hours between 8am-6pm Position Summary 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 SummaryHealth Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.<ul> <li>Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.</li> <li>Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.</li> <li>Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.</li> <li>Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.</li> <li>Uses customer service threshold framework to make financial decisions to resolve member issues.</li> <li>Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).</li> <li>Utilizes all relevant information to effectively influence member engagement.</li> <li>Takes immediate action when confronted with a problem or made aware of a situation.</li> <li>Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.</li> <li>Identifies member needs beyond the initial inquiry by answering the unasked questions.</li> <li>Resolves issues without or with limited management intervention.</li> <li>Provides education to members to support them in managing their health.</li> <li>Responds quickly to meet customer needs and resolve problems while avoiding over-committing.</li> <li>Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.</li> <li>Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.</li> <li>Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.</li> <li>Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.</li> <li>Partners with other departments to deliver client specific presentations.</li> <li>Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.</li> <li>Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer, including circumstances, problems, expectations and needs.</li> <li>Asks probing questions to identify the underlying customer needs.</li> <li>Appropriately transitions conversations to explore possibilities for extending customer interactions.</li> <li>Guides members to the appropriate health resource Offers alternatives where appropriate.</li> <li>Acts with the best interest of customer in mind and central to all interactions.</li> <li>Collaborates with colleagues and co-workers to deliver a world class customer experience.</li> <li>Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.</li> <li>May participate in preparation and presentation of client specific presentations.</li> <li>May track and trend data.</li> <li>Coaches, trains and assists in the development of call center staff, as required.</li> <li>Participates in and/or leads special projects/initiatives addressing service issues, as necessary.</li> <li>Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.</li> <li>Delivers internal quality reviews.</li> <li>Provides appropriate support in third party audits when required.</li> <li>Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.</li> </ul> Required Qualifications<ul><li>Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.</li></ul><ul> <li>Effective organizational skills and ability to manage multiple tasks.</li> <li>Effective communication skills, both verbal and written</li> <li>Experience working with computers</li> </ul> Education High School DiplomaAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This 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. 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

39 Jobs in Baxley, GA 31513, USA