AMVETS Jobs

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.

The Medicare PAR Provider Appeals organization is crucial to addressing providers issues promptly and efficiently. The Medicare appeals team is seeking a self-motivated and detail-oriented Senior Manager to join our team. As the Senior Manager, Complaint & Appeals (Medicare) you will have a demonstrated ability to work in a highly matrixed organization with proven success in such an environment. In partnership with our Medicare PAR leadership team, this position will help develop and maintain operational effectiveness and reporting for the management and execution for all operational functions. You will develop end-to-end reporting operational and capacity planning tools, develop new reporting toolkit to effectively measure and evaluate appeal processes, fostering collaboration with stakeholders, and driving continuous learning and skill development within the team.

Key Responsibilities:

• Plans, monitors and manages day-to-day operational reporting.

• Develop weekly/ monthly capacity planning based on volume of cases, handle time to forecast headcount.

• Oversee BOT reporting and analytics and develop enhanced reporting to monitor day to day performance.

• Support special projects from initiation through completion, including monitoring results and staffing.

• Conduct regular reviews of forecasting and capacity planning.

Requirements:

• Acts as a program leader for day-to-day reporting and proactively monitors operational results (i.e. KPIs, productivity, capacity planning)

• Identifies process or system gaps and recommends opportunities to enhance strategic direction.

• Coordinates and leads weekly/monthly operational results calls.

• Collaborates with management at regular staff meetings to review ongoing alignment of reporting and metrics

• Develop, implement and maintain reporting tools to support achieving business goals.

• Designs the change management protocol to effectively respond to obstacles that may arise during project and program lifecycles.

• Utilizes data visualization tools and techniques to present project and program data in a visually appealing easily understandable format.

Preferred Qualifications:

• 5+ years work experience, with operational reporting and tools

• Report expertise specific to technology solutions (i.e. tableau, Quickbase)

• Execution and delivery: Proficient in developing and delivering reporting capabilities and or technology solutions to drive efficiencies in support of business optimization.

• Industry Experience: Experience in health insurance/healthcare, clinical policy, claims, Utilization management, Clinical Claim Review or Appeals, providing well-rounded perspective on strategic initiatives.

• Analytical Skills: Proficient in creating impactful reports and analytics, with the ability to effectively communicate ideas and strategies to diverse audiences.

Education:

Bachelor's degree preferred or equivalent experience.

Pay Range

The 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 people

We 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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/20/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.