Manager, Pharmacy Adjudication, Affordability

CVS Health

Manager, Pharmacy Adjudication & Affordability at CVS Health. Transforming healthcare to make prescriptions more accessible and affordable for patients.

Posted 7/2/2026full-timeWoonsocket • Connecticut, Massachusetts, New York, Rhode Island • 🇺🇸 United StatesMid-LevelSenior💰 $66,330 - $145,860 per yearWebsite

About the role

Key responsibilities & impact

Serve as a subject matter expert in prescription adjudication, with deep expertise in: Coordination of Benefits (COB) sequencing rules, NCPDP standards and transaction logic, plan design constraints across PBM, retail, and third-party affordability programs
Design, configure, and optimize complex plan sequencing strategies that maximize utilization of patient benefits
Partner with senior leadership to translate affordability strategies into executable adjudication logic and workflows.
Support the development of curated affordability journeys by ensuring adjudication pathways reflect real-world patient scenarios
Identify, quantify, and prioritize patient affordability opportunities using pharmacy claims and performance data to reduce out-of-pocket costs and cost-related abandonment.
Manage multiple concurrent initiatives, balancing priorities, timelines, and interdependencies across stakeholders.
Support end-to-end execution of adjudication and affordability initiatives, including requirements refinement, configuration validation, UAT planning and execution, defect identification and resolution.

Requirements

What you’ll need

5–7 years of experience in adjudication, pharmacy operations, PBM operations, healthcare technology, or analytics.
Strong analytical and problem-solving skills.
Experience collaborating across teams and influencing outcomes.
Excellent communication and presentation skills.
Proficiency in Excel and PowerPoint.
7+ years experience with affordability programs such as coupons or discount card processing or contracting (preferred).
Knowledge of pharmacy adjudication or COB processes (preferred).
NCPDP membership experience (preferred).
Experience with UAT, testing, or IT collaboration (preferred).
Experience working in cross-functional environments (preferred).

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Adjudication LogicPlan Design ConstraintsPharmacy Claims AnalysisUAT Planning And ExecutionConfiguration Validation

Soft Skills

Excellent CommunicationCollaboration Across TeamsInfluencing OutcomesPresentation Skills

Certifications

NCPDP Membership