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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.Position Summary<ul> <li>Guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.</li> <li>Manages contract performance, and drives the development and implementation of value based contract relationships in support of business strategies.</li> <li>Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.</li> <li>Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.</li> <li>Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.</li> <li>Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.</li> </ul>Required Qualifications<ul> <li>Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.</li> <li>A minimum of 5 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with hospitals.</li> <li>Understanding knowledge of Value Based Contracting.</li> <li>Microsoft Office/Excel proficient</li> </ul>Preferred Qualifications<ul> <li>Healthcare Industry experience with either a payer or provider</li> <li>Strong communication, critical thinking, problem resolution and interpersonal skills.</li> <li>Internal Aetna system knowledge a plus.</li> <li>Understanding of Medicare &amp; Commercial.</li> <li>Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.</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:$75,400.00 - $182,549.00 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: 05/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Provider Network Contracting (MA/RI)

CompanyCox Communications, Inc.Job Family GroupBusiness OperationsJob ProfileWorkforce Analytics Analyst IIManagement LevelIndividual Contributor Flexible Work Option Can work remotely but need to live in the specified city, state, or regionTravel %Yes, 5% of the timeWork ShiftDayCompensationCompensation includes a base salary of $59,600.00 - $89,400.00. The base salary may vary within the anticipated base pay range based on factors such as the ultimate location of the position and the selected candidate’s knowledge, skills, and abilities. Position may be eligible for additional compensation that may include an incentive program.Job DescriptionThe Workforce Analytics Analyst II supports Customer Care, Sales, Retention or Collections. As an analyst, individuals will be part of a team responsible for all scheduling activities for internal resources. Key activities include the creation of optimal schedules, assignment of schedules by sites, conducting shift bids and maintaining a collision calendar of all off-phone requests. Workforce Analytics Analysts are accountable for optimizing staffing against required staffing, to ensure key performance indicators are consistently met.What You’ll Do<ul> <li>Create and maintain optimal shifts which effectively meet business need &amp; employee need.</li> <li>Establish process for offering new hire schedules while allowing existing employees to bid up.</li> <li>Establish process for shift bids, which include optimal frequency and process by which bidding will be facilitated.</li> <li>As part of bid process, allocate shifts by site based on hours of operation and time zone.</li> <li>Maintain accurate employee records in eWFM and other databases by processing status changes in a timely manner.</li> <li>Establish planning timelines in accordance with Forecasting team for scheduling deadlines.</li> <li>Effectively support Operations in pre-planning all shrinkage.</li> <li>Maintain a collision calendar of all scheduled / requested events.</li> <li>Escalate any requests that exceed allowable shrinkage.</li> <li>Establish PTO allowances for each LOB that align with allowable shrinkage guidelines and the staff’s PTO accrual.</li> <li>Audit PTO balances on a quarterly basis to ensure PTO taken and PTO allowances remaining are sufficient to exhaust PTO balances.</li> <li>Identify and escalate any risk to KPI attainment.</li> <li>Regularly track schedule efficiency results to help determine timing for full or partial shift bids.</li> <li>Participate in the WFM weekly business review.</li> <li>Proactively make recommendations on staffing to maximize KPI’s.</li> <li>Partner with Forecasting and Mission Control to ensure end-to-end planning and execution is aligned.</li> <li>Research compliance and other related issues and questions for leadership and/or Human Resources.</li> <li>Identify potential process improvements.</li> <li>Back up Call Volume Analyst duties as needed.</li> </ul>What’s In It For You At Cox, we reward your hard work with meaningful benefits. First, we offer a highly competitive compensation package, 401(k) with a generous company match, comprehensive healthcare, life, and disability benefits, plus numerous other benefits, including adoption assistance, pet insurance, and discounts on travel and cars! We value people more than technology. That means you’ll work within a culture and with a team that values your leadership, your experience, your contributions, and you – yes, you – as a person. We believe recognition is important, and Cox strives to celebrate those who help make us successful every day. We also offer boundless opportunities for growth; you can sharpen your skills, learn a new talent, join a mentoring program, even earn an advanced degree. You’ll find the potential for lateral or upward career growth within the Cox family businesses, including the innovative startups in transportation mobility, clean tech and more. Who You Are Minimum<ul> <li>Bachelor’s degree in a related discipline and 2 years’ experience in a related field (Business, IT, etc.). The right candidate could also have a different combination, such as a master’s degree and up to 2 years’ experience; or 6 years’ experience in a related field</li> <li>2+ years successful experience researching and analyzing qualitative and quantitative data in a related field (Field Operations, Customer Care, Data Analysis, Collections, Finance, Business Operations, etc.).</li> <li>2+ years of experience forecasting and scheduling with Workforce Management software.</li> <li>2+ years successful experience using Microsoft Office Suite applications in a work setting with strong knowledge in Excel. </li> <li>Proven aptitude for math and analytics.</li> <li>Excellent soft skills such as: interpersonal, leadership, presentation, and collaborative to all for working effectively with teams throughout the organization.</li> </ul>Preferred <ul> <li>Master's degree in a related discipline plus up to 2 years experience in a related field.</li> <li>Experience working in communications industry with a focus on telecommunications, data, cable.</li> <li>Advance knowledge of eWFM forecast groups and settings.</li> </ul>BenefitsThe Company offers eligible employees the flexibility to take as much vacation with pay as they deem consistent with their duties, the company’s needs, and its obligations; seven paid holidays throughout the calendar year; and up to 160 hours of paid wellness annually for their own wellness or that of family members. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Cox Communications is all about creating moments of real human connection; and for employees, that’s true both in the workplace and in the problems we solve for customers. From building advertising solutions to unleashing IoT technologies to creating an exceptional experience for customers in our retail locations and online, we’re creating a world that is smarter and more connected. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer – All qualified applicants/employees will receive consideration for employment without regard to that individual’s age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. <h3> </h3>

Cox Communications

Workforce Analytics Analyst II

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.Job DescriptionReporting to the SVP, CFO of Pharmacy and Consumer Wellness (PCW), the VP, Segment FP&amp;A - PCW will serve as a trusted advisor to the Pharmacy and Consumer Wellness leadership team in support of the front store and retail pharmacy businesses across the company’s more than 9,000 CVS Pharmacy® locations. This role will lead and develop a team of finance colleagues to optimize partnership with key executives, drive the highest level of analysis and provide actionable insights to aid in strategic and operational decision making. The VP, Segment FP&amp;A, PCW will provide strategic direction to their direct reports and lead all major end-to-end planning, reporting, and capital investment processes across the PCW segment. Through the alignment of priorities, milestones and measurements across PCW, this role will ensure elite execution of business imperatives. Major Responsibilities<ul> <li>Coach and mentor a team of finance professionals, prioritizing their growth and development.</li> <li>Champion an innovative and collaborative environment.</li> <li>Lead the development of the PCW segment’s operating plans and quarterly forecasts. Ensure that plans are integrated and coordinated across business segments, and with enterprise partners.</li> <li>Partner with PCW business strategy lead, CFO and business leaders to build and execute short and long-range strategic plans.</li> <li>Manage and strategically position the management process for the PCW business; navigate process across the enterprise.</li> <li>Accountability for all planning, reporting and business performance management across lines of business.</li> <li>Monitor progress against multi-year strategic, financial and operational metrics and targets.</li> <li>Lead PCW capital investment, forecasting and management process.</li> <li>Lead PCW data, visualization and automation work across the finance team.</li> <li>Develop and execute communications / plans for senior leaders, to summarize business results, business issues, recommended solutions.</li> <li>Act as liaison between respective business executives and other internal and external constituents.</li> <li>Proactively play key role on PCW executive leadership team as “enterprise voice” on PCW/Finance initiatives to ensure that enterprise partners are connecting the dots.</li> <li>Centrally coordinate operational and strategic planning and oversight.</li> <li>Coordinate development and monitor implementation of PCW action plans to seize competitive opportunities and/or respond to performance shortfalls/plan variances.</li> <li>Must have strong relationship-building and collaboration skills, as well as very strong financial acumen.</li> <li>Experience with and ability to act in a leadership capacity across the PCW leadership team—drive management process meetings, capital plan meetings, operating plan meetings, etc.</li> <li>Develop strong relationships across the enterprise to collaborate and effectively represent and balance PCW interests with enterprise goals.</li> </ul>Required Qualifications<ul> <li>20+ years of experience in Healthcare and Finance</li> <li>5+ years of people leader experience</li> <li>Experience at leading execution and delivery (planning, delivering, and supporting)</li> <li>Adept at business intelligence</li> <li>Adept at collaboration and teamwork</li> <li>Strong oral and written communication skills</li> <li>Experience in problem solving and decision-making skills</li> <li>Mastery of growth mindset (agility and developing yourself and others) </li> <li>Open to location but will require regular travel to Rhode Island office</li> <li>Remote will require regular travel to Hartford office</li> </ul>EducationBachelor's degree (required)Master's degree (preferred)The typical pay range for this role is:$220,000.00 - $320,000.00This 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. This position also includes an award target in the company’s equity award program.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/benefits" target="_blank">jobs.CVSHealth.com/benefits</a>We anticipate the application window for this opening will close on: 05/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through <a href="#">ColleagueRelations@CVSHealth.com</a> If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

VP, Segment FP&A - Pharmacy and Consumer Wellness

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: As an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. In addition, as an Oncology Pharmacist you will assist front-line colleagues (i.e. Staff Pharmacists and Representatives) with oncology process/procedural support by acting as a subject matter expert and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education, continuing education and certification. This position also supports departmental leadership in identifying issues, concerns and trends within the workflow process. The Pharmacist will partner with our Lead Oncology Pharmacist to help develop/deliver formal clinical training sessions, delivering them to staff to enhance their clinical knowledge base in relation to the oncology disease states and therapies. Strong effective communication is required to ensure the thorough distribution, understanding and execution of required knowledge transfer to internal and external stakeholders. The Pharmacist will be expected to work closely with other teams and departments throughout the company including Case Review Unit (CRU), Commercial PA &amp; appeals, internal Medical Directors, Clinical Development, and our Client Liaison team. This is a work-from-home role open to qualified candidates within the United States. Candidate must be willing and able to work 9am-5:30pm EST M-F, with the ability to flex to later or earlier if needed for training, client meetings, or other business needs. PRIMARY DUTIES AND RESPONSIBILITIES: 1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design with a focus on oncology reviews. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. % Time: 70% 2. A Leader in identifying and solving issues, concerns and trends within the workflow process that need to be addressed at a higher level resulting in optimal performance and outcomes. Responsible for assisting front-line colleagues (i.e. Staff Pharmacists and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. % Time: 20% 3. Assist with standard or client specific oncology review process changes as needed. % Time: 5% 4. Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients. % Time: 5%EDUCATIONBS in Pharmacy or PharmDRequired: Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP) REQUIRED SKILLS &amp; OTHER MINIMUM REQUIRED QUALIFICATIONS: • Active pharmacist license in the state of residence that is in good standing.• Board Certified Oncology Pharmacist (BCOP) required • 2+ years clinical pharmacist experience, inclusive of prior authorization experience• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential. • Must be able to multitask and utilize multiple system applications simultaneously. • Must be able to utilize available resources independently and provide high quality work. • Must demonstrate problem solving ability and attention to detail. • Demonstrated clinical expertise in the oncology therapy arena, with recent career focus in the oncology area. • Ability to adapt and change with workflow and shifting priorities. • Ability to work effectively in a team environment and provide mentorship to front line staff on the PA team. • Must possess excellent written, verbal, grammar, and listening communication skills. • Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner. • Ability to maintain confidentiality of PHI (Protected Health Information). ESSENTIAL FUNCTIONS: 1. Regular and predictable attendance. 2. Colleague will be required to work mandatory overtime/extended work week when needed. 3. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.4. Adhere to all policies and procedures. 5. Attend on-going training and development meetings. Physical Requirements: 1. Sits at desk for long periods of time. 2. Talking on phone for extended periods of time. 3. Computer use for extended periods of time. 4. Reading a computer screen. WORK ENVIRONMENT: Work from an approved work-from-home location.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This 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: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

<h1>Financial Services - Data Risk Management, Manager</h1> <h1>Financial Services - Data Risk Management, Manager</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Manager_619741WD?source=US_EXP_Careers" target="_blank">Apply</a> Job Category Data and Analytics Level Manager Specialty/Competency Data, Analytics &amp; AI Time Type Full time Travel Requirements Up to 60% Job ID 619741WD Location(s) NC-Charlotte, IL-Chicago, DC-Washington, MA-Boston, NJ-Florham Park, NY-New York A career within Data and Analytics services will provide you with the opportunity to help organisations uncover enterprise insights and drive business results using smarter data analytics. We focus on a collection of organisational technology capabilities, including business intelligence, data management, and data assurance that help our clients drive innovation, growth, and change within their organisations in order to keep up with the changing nature of customers and technology. We make impactful decisions by mixing mind and machine to leverage data, understand and navigate risk, and help our clients gain a competitive edge. Our team helps clients navigate various analytics applications to get the most value out of their technology investment and foster confidence in their business intelligence. As part of our team, you'll help our clients implement enterprise content and data management applications that improve operational effectiveness and provide impactful data analytics and insights. To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As a Manager, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: <ul> <li>Develop new skills outside of comfort zone.</li> <li>Act to resolve issues which prevent the team working effectively.</li> <li>Coach others, recognise their strengths, and encourage them to take ownership of their personal development.</li> <li>Analyse complex ideas or proposals and build a range of meaningful recommendations.</li> <li>Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.</li> <li>Address sub-standard work or work that does not meet firm's/client's expectations.</li> <li>Use data and insights to inform conclusions and support decision-making.</li> <li>Develop a point of view on key global trends, and how they impact clients.</li> <li>Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.</li> <li>Simplify complex messages, highlighting and summarising key points.</li> <li>Uphold the firm's code of ethics and business conduct.</li> </ul> The Opportunity As part of the Data and Analytics - Business Intelligence team you are responsible for leading efforts in developing and implementing data-driven strategies to drive business growth and enhance decision-making. As a Manager, you guide and mentor your team, facilitating the successful planning, execution, and completion of projects while maintaining exemplary standards and leveraging team strengths to meet client expectations. You play a crucial role in aligning data initiatives with organizational goals, managing data strategy programs, and embracing technology and innovation to improve delivery. Responsibilities - Oversee the planning and completion of data initiatives, maintaining quality standards - Align data strategies with organizational objectives to drive growth - Leverage team strengths to meet and exceed client expectations - Manage data strategy programs to improve decision-making - Foster a culture of continuous improvement and learning within the team What You Must Have - Bachelor's Degree in Computer and Information Science, Computer and Information Science &amp; Accounting, Economics, Economics and Finance &amp; Technology, Operations Management/Research, or Statistics - 5 years of experience What Sets You Apart - Master's Degree in Computer Science, Computer Engineering, or Engineering preferred - Proficiency in data risk management and technology risk management - Developing data-driven strategies for business growth - Aligning data initiatives with organizational goals - Managing data strategy program success - Programming using Python and SQL - Designing advanced analytics solutions and AI/ML models - Understanding of Master Data Management and Data Governance - Supporting reliable and scalable solutions architectures Learn more about how we work: <a href="https://pwc.to/how-we-work" target="_blank">https://pwc.to/how-we-work</a> PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: <a href="https://pwc.to/H-1B-Lottery-Policy" target="_blank">https://pwc.to/H-1B-Lottery-Policy</a>. All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer. The salary range for this position is: $100,000 - $232,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: <a href="https://pwc.to/benefits-at-a-glance" target="_blank">https://pwc.to/benefits-at-a-glance</a> <h1>Financial Services - Data Risk Management, Manager</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Manager_619741WD?source=US_EXP_Careers" target="_blank">Apply</a>

Financial Services - Data Risk Management, Manager

Cox Automotive Inc.

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.Sr. Manager, Clinical AssumptionsPosition Summary:As Sr. Manager, Clinical Assumptions, you will join the Pharmaceutical Forecasting and Analysis team supporting the unified PBM Connected Ecosystem to drive accountability and accuracy across the Caremark Organization. The Sr. Manager, Clinical Assumptions will play a key role in developing, supporting and maintaining PBM Assumptions. In this role you will act as a subject material expert in the Clinical field driving accuracy in financial modeling of the Underwriting Ecosystem by connecting with Business Process Owners and Data Architects to emulate future member behavior with the financial modeling. Primary responsibilities include coordinating with Formulary Management to stay abreast of upcoming strategic changes and decode their financial impact, drive accurate modeling by providing clinical guidance when needed on therapeutic equivalencies or interchangeability, and act as a representative of the Client Financial Analysis and Optimization (CFAO) organization with Trade &amp; Medical Affairs as needed.Additionally, this position will:<ul> <li>Partner with Business resources to gather, refine and evaluate new clinical assumptions that influence the business.</li> <li>Foster strong relationships within the PBM Ecosystem to elevate accurate financial stewardship as it related to clinical assumptions.</li> <li>Support discussions that are highly complex.</li> <li>Drive results utilizing durable and automation focused solutions.</li> <li>Prioritize effectively and efficiently to meet internal and external customer needs.</li> <li>Support the translation market dynamics to usable business intelligence.</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>7+ years professional clinical and/or financials experience, preferably within a PBM or health plan</li> <li>1+ years experience working with health plans, employer clients, or coalitions/TPAs, with multiple lines of business with different funding arrangements.</li> <li>Able to travel up to 10% of the time.</li> </ul>Preferred Qualifications:<ul> <li>Expertise in Utilization Management and Formulary Management.</li> <li>Knowledge and experience with Microsoft applications (Excel, Power Point, Word, Outlook, Teams).</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>Knowledge of relational databases and warehouses, advanced SQL, VBA, OLAP and SAS skills.</li> <li>Experience managing complex projects in a matrix environment.</li> <li>Ability to summarize complex pharmaceutical findings 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>AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.</li> <li>Previous PBM Pricing, Underwriting, Data analytics or Financial Analysis experience</li> </ul>Education:<ul> <li>BS Pharmacy or PharmD</li> <li>Licensed Pharmacist</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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Manager, Clinical Assumptions

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 Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.- Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.- Identifies and reports possible claim overpayments, underpayments and any other irregularities.- Performs claim rework calculations.- Distributes work assignment daily to junior staff.- Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- 18+ months of medical claim processing experience.- Experience in a production environment.- Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience.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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

<h1>Financial Services - Data Risk Management, Senior Associate</h1> <h1>Financial Services - Data Risk Management, Senior Associate</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Senior-Associate_619742WD?source=US_EXP_Careers" target="_blank">Apply</a> Job Category Data and Analytics Level Senior Associate Specialty/Competency Data, Analytics &amp; AI Time Type Full time Travel Requirements Up to 60% Job ID 619742WD Location(s) NC-Charlotte, IL-Chicago, DC-Washington, MA-Boston, NJ-Florham Park, NY-New York A career within Data and Analytics services will provide you with the opportunity to help organisations uncover enterprise insights and drive business results using smarter data analytics. We focus on a collection of organisational technology capabilities, including business intelligence, data management, and data assurance that help our clients drive innovation, growth, and change within their organisations in order to keep up with the changing nature of customers and technology. We make impactful decisions by mixing mind and machine to leverage data, understand and navigate risk, and help our clients gain a competitive edge. Our team helps clients navigate various analytics applications to get the most value out of their technology investment and foster confidence in their business intelligence. As part of our team, you'll help our clients implement enterprise content and data management applications that improve operational effectiveness and provide impactful data analytics and insights. To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As a Senior Associate, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: <ul> <li>Use feedback and reflection to develop self awareness, personal strengths and address development areas.</li> <li>Delegate to others to provide stretch opportunities, coaching them to deliver results.</li> <li>Demonstrate critical thinking and the ability to bring order to unstructured problems.</li> <li>Use a broad range of tools and techniques to extract insights from current industry or sector trends.</li> <li>Review your work and that of others for quality, accuracy and relevance.</li> <li>Know how and when to use tools available for a given situation and can explain the reasons for this choice.</li> <li>Seek and embrace opportunities which give exposure to different situations, environments and perspectives.</li> <li>Use straightforward communication, in a structured way, when influencing and connecting with others.</li> <li>Able to read situations and modify behavior to build quality relationships.</li> <li>Uphold the firm's code of ethics and business conduct.</li> </ul> The Opportunity As part of the Data and Analytics - Business Intelligence team you are responsible for leading efforts in developing and implementing data-driven strategies to drive business growth and enhance decision-making. As a Senior Associate, you play a crucial role in aligning data initiatives with organizational goals, managing data strategy programs, and embracing technology and innovation to improve delivery. Responsibilities - Oversee the planning and completion of data initiatives, maintaining quality standards - Align data strategies with organizational objectives to drive growth - Leverage team strengths to meet and exceed client expectations - Manage data strategy programs to improve decision-making - Foster a culture of continuous improvement and learning within the team What You Must Have - Bachelor's Degree in Computer and Information Science, Computer and Information Science &amp; Accounting, Economics, Economics and Finance &amp; Technology, Operations Management/Research, or Statistics - 3 years of experience What Sets You Apart - Master's Degree in Computer Science, Computer Engineering, or Engineering preferred - Proficiency in data risk management and technology risk management - Developing data-driven strategies for business growth - Aligning data initiatives with organizational goals - Managing data strategy program success - Programming using Python and SQL - Designing advanced analytics solutions and AI/ML models - Understanding of Master Data Management and Data Governance - Supporting reliable and scalable solutions architectures Learn more about how we work: <a href="https://pwc.to/how-we-work" target="_blank">https://pwc.to/how-we-work</a> PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: <a href="https://pwc.to/H-1B-Lottery-Policy" target="_blank">https://pwc.to/H-1B-Lottery-Policy</a>. All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer. The salary range for this position is: $84,000 - $202,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: <a href="https://pwc.to/benefits-at-a-glance" target="_blank">https://pwc.to/benefits-at-a-glance</a> <h1>Financial Services - Data Risk Management, Senior Associate</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Senior-Associate_619742WD?source=US_EXP_Careers" target="_blank">Apply</a>

Financial Services - Data Risk Management, Senior Associate

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 SummaryBring 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> <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 Education High School Diploma </li> </ul>Anticipated 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: 05/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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