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Your work days are brighter here.At Workday, it all began with a conversation over breakfast. When our founders met at a sunny California diner, they came up with an idea to revolutionize the enterprise software market. And when we began to rise, one thing that really set us apart was our culture. A culture which was driven by our value of putting our people first. And ever since, the happiness, development, and contribution of every Workmate is central to who we are. Our Workmates believe a healthy employee-centric, collaborative culture is the essential mix of ingredients for success in business. That’s why we look after our people, communities and the planet while still being profitable. Feel encouraged to shine, however that manifests: you don’t need to hide who you are. You can feel the energy and the passion, it's what makes us unique. Inspired to make a brighter work day for all and transform with us to the next stage of our growth journey? Bring your brightest version of you and have a brighter work day here.At Workday, we value our candidates’ privacy and data security. Workday will never ask candidates to apply to jobs through websites that are not Workday Careers. Please be aware of sites that may ask for you to input your data in connection with a job posting that appears to be from Workday but is not.In addition, Workday will never ask candidates to pay a recruiting fee, or pay for consulting or coaching services, in order to apply for a job at Workday.About the TeamWorkday’s Consulting teams are driven by a passion for our products and the success of our customers in implementing our best in class cloud solutions. We’re a diverse group of people, with an invaluable mix of experience and backgrounds, located across multiple locations within the region. We are often remote from one another but that doesn’t stop our sense of collaboration, supportiveness, and fun.About the RoleWe are looking for a hardworking, innovative and collaborative Absence / Time Tracking / Scheduling Consultant to join our team. In this role you will ensure the successful implementation of the Workday Absence, Time Tracking and Scheduling solutions with customers through product and implementation expertise. The ideal candidate for this position should have extensive experience implementing or supporting Absence / Time Tracking / Scheduling systems, requirements capturing, configuration, data conversion, and testing. You should be detail oriented, self-motivated, proactive, results-oriented and able to successfully partner with customers and your project team. Be ready to be challenged and have fun!<ul> <li>Master at least two of the following Workday modules: Absence, Time Tracking, Scheduling.</li> <li>Perform the following on a client engagement: understand client business requirements, configure the Workday solution, demonstrate the configurations through the development of prototype systems, assist the client in testing the Workday solution.</li> <li>Work with the client to help convert legacy data into Workday.</li> <li>Assist the Integration team in helping to configure and test integrations between Workday and third party/custom solutions.</li> <li>Understand Workday’s Implementation Methodology and use it on all client engagements.</li> <li>Ensure the client takes advantage of Workday's proven solutions.</li> <li>Mentor and share product knowledge with other consultants.</li> <li>Help deliver successful project outcomes and lasting client relationships.</li> </ul>About You"Proven mentorship skills, with the ability to foster individual growth and development through effective communication, constructive feedback, and goal setting, are highly valued." "Strong influencing skills, including persuasive communication and the ability to drive consensus and effectively collaborate with stakeholders, are crucial." Basic Qualifications: Senior Absence/Time Tracking/Scheduling Functional Consultant<ul> <li>A minimum of 5 years implementing two of the following solutions: Absence, Time Tracking, Scheduling.</li> <li>Previous consulting experience with a consulting/software company required.</li> <li>Experience implementing Workday or similar applications.</li> </ul>Basic Qualifications: Principal Absence/Time Tracking/Scheduling Functional Consultant<ul> <li>A minimum of 10 years implementing two of the following solutions: Absence, Time Tracking, Scheduling.</li> <li>Previous consulting experience with a consulting/software company required.</li> <li>Experience implementing Workday or similar applications.</li> </ul>Other Qualifications<ul> <li>Functional experience - Workday Absence, Time Tracking and/or Scheduling.</li> <li>Excellent verbal, written, and interpersonal communication skills are a must, including active listening and the ability to tailor communication style to diverse audiences.</li> </ul><ul> <li>Strong industry knowledge is essential, including staying abreast of current trends, competitive landscapes, and regulatory environments to contribute to strategic planning, risk management, and identifying new opportunities.</li> <li>Strong influencing skills, including persuasive communication and the ability to drive consensus and effectively collaborate with stakeholders, are crucial.</li> <li>Proven mentorship skills, with the ability to foster individual growth and development through effective communication, constructive feedback, and goal setting, are highly valued.</li> <li>Comprehensive product knowledge, including a thorough understanding of product features, benefits, applications, and market positioning, is essential.</li> <li>Exceptional relationship management skills are crucial, with a focus on building and maintaining strong relationships with clients, partners, and colleagues to foster collaboration, loyalty, and a positive work environment.</li> <li>Proven ability to effectively gather and analyze requirements through various techniques, ensuring project clarity and alignment with stakeholder needs, is critical.</li> <li>Proven project management experience and a passion for customer service.</li> <li>Strong solutions design skills, with the ability to analyze business challenges and develop effective solutions that leverage technology and optimize resources, are highly desired.</li> <li>Expertise in strategic business consulting, including market analysis, financial acumen, and strategic planning, to drive organizational growth and performance, is strongly desired.</li> <li>Excellent task management skills, with a proven ability to prioritize, organize, and execute tasks effectively to enhance workflow and productivity, are essential.</li> <li>Exceptional teamwork skills, including collaboration, communication, and contributing to a positive and productive work environment, are vital.</li> <li>Excellent time management skills, with the ability to prioritize, organize, and effectively manage workload to meet deadlines and enhance productivity, are key to success in this role.</li> <li>Experience deploying multiple implementation projects simultaneously a plus.</li> <li>Bachelor's degree or relevant experience required.</li> <li>Ability to travel up to 30% of the time.</li> </ul> Workday Pay Transparency StatementThe annualized base salary ranges for the primary location and any additional locations are listed below. Workday pay ranges vary based on work location. As a part of the total compensation package, this role may be eligible for the Workday Bonus Plan or a role-specific commission/bonus, as well as annual refresh stock grants. Recruiters can share more detail during the hiring process. Each candidate’s compensation offer will be based on multiple factors including, but not limited to, geography, experience, skills, job duties, and business need, among other things. For more information regarding Workday’s comprehensive benefits, please <a href="https://workdaybenefits.com/us/welcome-to-workday-benefits/prospective-workmates" target="_blank">click here</a>.Primary Location: USA.IL.Chicago Primary Location Base Pay Range: $147,400 USD - $221,100 USD Additional US Location(s) Base Pay Range: $133,300 USD - $236,800 USDIf performed in Colorado, the pay range for this job is $140,400 - $210,500 USD based on min and max pay range for that role if performed in CO.The application deadline for this role is the same as the posting end date stated as below: 06/09/2025 Our Approach to Flexible Work With Flex Work, we’re combining the best of both worlds: in-person time and remote. Our approach enables our teams to deepen connections, maintain a strong community, and do their best work. We know that flexibility can take shape in many ways, so rather than a number of required days in-office each week, we simply spend at least half (50%) of our time each quarter in the office or in the field with our customers, prospects, and partners (depending on role). This means you'll have the freedom to create a flexible schedule that caters to your business, team, and personal needs, while being intentional to make the most of time spent together. Those in our remote "home office" roles also have the opportunity to come together in our offices for important moments that matter.Pursuant to applicable Fair Chance law, Workday will consider for employment qualified applicants with arrest and conviction records.Workday is an Equal Opportunity Employer including individuals with disabilities and protected veterans.Are you being referred to one of our roles? If so, ask your connection at Workday about our Employee Referral process!

Workday

Principal Absence Time Tracking Scheduling Functional 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.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.

CVSHealth

Manager, Assumptions Governance

TK MaxxAt TJX Europe, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritises your development. Whether you’re working in our Distribution Centers, Corporate Offices, or Retail Stores—TK Maxx &amp; Homesense, you’ll find abundant opportunities to learn, thrive, and make an impact. Come join our TJX team—a Fortune 100 company and the world’s leading off-price retailer.Job Description:TK Maxx jest częścią grupy TJX Europe, w której znajdziesz różne produkty, ale łączy nas ta sama cecha - poszukiwanie skarbów, które dają nam radość. Od stylowych perełek, znanych marek do unikatowej biżuterii, gwarantujemy naszym klientom szalone możliwości każdego dnia. Równie dynamiczna jest nasza praca. W sklepach nieustannie coś się dzieje, co sprzyja rozwojowi i zaangażowaniu. Każdy dzień daje możliwość odkrycia czegoś nowegoDołącz do naszego zespołu na stanowisku: Sprzedawcy Zatrudnienie w niepełnym wymiarze godzin Stawka: 29.45 PLN brutto Szukasz pracy, dzięki której zajdziesz daleko? Sprzedawcy pełnią rolę ambasadorów naszej marki. Muszą być zatem pewni siebie i komunikatywni. Wyobraź sobie pracę, w której nie ma dwóch takich samych dni. W sklepach nieustannie coś się dzieje – w jednej chwili obsługujesz klienta, a za moment rozpakowujesz dostawę pełną nowych niesamowitych produktów. Korzyści z bycia sprzedawcą w TK Maxx nie kończą się na pracy z zespołem świetnych ludzi. Oferujemy pełną gamę benefitów dla wszystkich naszych pracowników. Są to: • konkurencyjne wynagrodzenie • ubezpieczenie na życie • prywatna opieka medyczna • karta sportowa • zniżka na wszystkie produkty dostępne w sklepach TK MaxxOdkryj to, co nas wyróżnia w TK Maxx - przekonasz się, że to coś więcej niż praca. Jesteśmy dynamiczną organizacją, razem współpracujemy, uczymy się i rozwijamy. Dołączając do naszego zespołu w sklepach, możesz liczyć na pełne wsparcie różnorodnej i zgranej grupy.Masz prawo wiedzieć, jakie informacje o Tobie posiadamy i w jaki sposób wykorzystujemy te informacje. W celu uzyskania bardziej szczegółowych informacji na temat wykorzystywania przez nas danych i praktyk ich udostępniania, prosimy odwiedzić: //<a href="http://www.mytjx.com/mytjx/Global_TJX_Privacy_Notice.pdf" target="_blank">www.mytjx.com/mytjx/Global_TJX_Privacy_Notice.pdf</a> i zapoznać się z naszą pełną Polityką PrywatnościAs proud as we are of our past success, it’s our future that excites us most. We strive to provide opportunities for growth, recognition and a competitive salary and benefits package. Share our determination to think bolder and bigger, and be part of our future. We consider all applicants for employment without regard to age, disability, gender, gender reassignment, marriage and civil partnerships, pregnancy and maternity, race, religion or belief and/or sexual orientation.Address:CH Riviera ul. Kazimierza Górskiego 2Location:EUR TK Maxx PL Store 719 - Gdynia Centrum Riviera

sprzedawca TK Maxx Gdynia niepełny etat

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 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. 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.

Health Concierge

CBRE

Transition Coordinator - Remote /  Eastern Time Zone

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.Effectively manages competitive and complex contractual relationships with TPAs and/or business partners in Europe, APAC, Africa and Middle East excluding Americas region in support of international network, medical cost management and overall claim/customer service strategies. Provide concierge level of service to our members via timely provision of required network access and proactive management of network relationships to ensure seamless direct settlement access. Job Responsibilities:<ul> <li>Manage TPA relationship with external vendors and own overall relationship with assigned TPAs in Europe, Africa, Middle East and APAC region.</li> <li>Oversee and manage contractual relationship with assigned TPA(s).</li> <li>Manage Third Party Risk Governance process for your assigned TPA(s).</li> <li>Manage ongoing Aetna compliance review process for your assigned TPA(s).</li> <li>Manage monthly billing / submission of TPA invoices for timely payment</li> <li>Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems.</li> <li>Ensure TPA guides, country guides and other internal materials are timely updated and up to date.</li> <li>Ensuring streamline member experience at each country level. Evaluate network options, network efficacies and optimize network utilization to increase direct billing.</li> <li>End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.</li> <li>Effectively negotiates and manages complex, competitive contractual relationships with providers/vendors according to prescribed guidelines in support of global and regional network strategies. Expand International provider network by contracting new direct pay providers and manage overall contracting process.</li> <li>Act as a Subject matter expert to assist internal sales, account management and sales support team on network and TPA questions / inquiries. Support sales as a subject matter expert on external broker / client calls.</li> <li>Oversee and manage any operational issues and queries regarding your assigned TPA(s).</li> <li>Manage day to day provider operations, either direct or through network business partners. Ensures operational efficiency for all network processes and infrastructure through proactive provider education and collaboration with Aetna International Service Operations</li> <li>Executes regional-specific strategies and tactics in response to market expectations</li> <li>Executes client-specific strategies and tactics for key expatriate clients.</li> <li>Responsible for understanding and managing medical cost issues and initiating appropriate action from the provider perspective</li> <li>Key contributor to enhanced provider service solution like provider portal and other digital solution, including development and/or management of process and technical support.</li> <li>Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas</li> </ul>Required Qualifications:<ul> <li>Benefits Management/Interacting with Medical Professionals</li> <li>Strong project management skills</li> <li>Prior client facing experience.</li> <li>Managing vendor relationships</li> <li>General Business/Demonstrating Business and Industry Acumen</li> <li>Sales/Managing Competitive Networks</li> </ul>Preferred Qualification:<ul> <li>Leadership/Fostering a Global Perspective</li> <li>Health Insurance understanding / business negotiations</li> <li>Service/Demonstrating Service Discipline</li> </ul>Education<ul><li>Bachelors 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: 06/21/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Network Vendor Manager

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<ul> <li>Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. </li> <li>Acts as a subject matter expert by providing training, coaching, or responding to complex issues. </li> <li>May handle customer service inquiries and problems.</li> </ul>Additional Responsibilities <ul> <li>Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. </li> <li>Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.</li> <li>Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.</li> <li>Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.</li> <li>Identifies and reports possible claim overpayments, underpayments and any other irregularities.</li> <li>Performs claim rework calculations.</li> <li>Distributes work assignment daily to junior staff.</li> <li>Trains and mentors claim benefit specialists.</li> <li>Makes outbound calls to obtain required information for claim or reconsideration.</li> </ul>Required Qualifications<ul> <li>2+ years medical claim processing experience.</li> <li>Experience in a production environment.</li> <li>Demonstrated ability to handle multiple assignments competently, accurately and efficiently.</li> </ul> Preferred Qualifications<ul> <li>Self funded medical claim processing experience.</li> <li>DG system knowledge.</li> </ul>Education<ul> <li>High School Diploma or GED required.</li> <li>Preferred Associates degree or equivalent work experience.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This 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: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

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 SummaryCVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Key Responsibilities of the UM Nurse Consultant (Includes but is not limited to)<ul> <li>Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.</li> <li>Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.</li> <li>Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.</li> <li>Communicates with providers and other parties to facilitate care/treatment.</li> <li>Identifies members for referral opportunities to integrate with other products, services and/or programs.</li> <li>Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.</li> </ul>Required Qualifications<ul> <li>Registered Nurse (RN) with current unrestricted US licensure required.</li> <li>2+ years clinical practice experience as an RN required.</li> <li>2+ Years Utilization Management experience.</li> <li>Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles.</li> </ul>Preferred Qualifications<ul> <li>Bilingual proficiency in Arabic, Korean, or Spanish preferred.</li> <li>1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications.</li> </ul>Education<ul> <li>Associate’s degree in Nursing.</li> <li>BSN preferred.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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: 06/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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