Claims Negotiation Manager

CVS Health

Claims negotiation manager leading No Surprises Act and out-of-network reimbursement operations at CVS Health. Driving compliant claim resolutions, provider relationships, team performance, and financial savings.

Posted 8/13/2026full-timeRemote • California, Idaho, Vermont • 🇺🇸 United StatesMid-LevelSenior💰 $66,330 - $145,860 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare claims negotiation, particularly with the No Surprises Act and out-of-network reimbursement methodologies, while driving operational excellence and compliance. Proven ability to lead teams, analyze performance metrics, and develop strategic negotiation initiatives that align with organizational goals.

Highest-signal resume keywords

Healthcare Claims NegotiationNo Surprises Act ExpertiseTeam LeadershipOperational Performance ManagementAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AdjudicationReimbursement MethodologiesNegotiation StrategiesPerformance Metrics AnalysisProcess Improvement

Soft Skills

Communication SkillsProblem-Solving SkillsCoaching and Development

Tools & Technologies

Microsoft Office SuiteExcelPowerPointWordOutlook

Industry Keywords

Provider ContractingNetwork ManagementHealthcare CompliancePayer RelationsCMS Regulations

About the role

Key responsibilities & impact

Lead the strategy, operations, and performance of the claims negotiation team supporting No Surprises Act claims and elective out-of-network reimbursement negotiations
Oversee negotiators focused on fair, compliant, and cost-effective claim resolutions
Serve as subject matter expert on out-of-network reimbursement methodologies, No Surprises Act regulations, and negotiation best practices
Provide strategic guidance across the organization
Lead daily negotiation operations in partnership with Product, Operations, Compliance, Analytics, and Client teams
Enhance negotiation strategies and support product development
Drive operational excellence and compliance with federal and state regulations
Monitor team performance and coach and develop negotiation talent
Analyze negotiation outcomes and market trends
Identify process improvement opportunities and shape negotiation products and services
Drive measurable financial savings and foster provider relationships and engagement
Contribute to business growth and organizational objectives

Requirements

What you’ll need

5+ years of healthcare claims, reimbursement, provider contracting, network management, or negotiation experience
2+ years of leadership experience managing teams and operational performance
Expertise in the No Surprises Act, out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication
Ability to interpret complex regulations and evaluate claim and reimbursement disputes
Ability to guide negotiation strategies, ensure compliance, and drive favorable financial and operational outcomes
2+ years of experience working with payers, providers, healthcare networks, or managed care organizations
Ability to lead cross-functional initiatives and support product development efforts
Strong analytical, communication, negotiation, and problem-solving skills
Proficiency in interpreting claims data, performance metrics, and reimbursement trends
Proficiency in Microsoft Office Suite, including Excel, PowerPoint, Word, and Outlook
Bachelor's degree or equivalent combination of education and healthcare industry experience
Preferred: experience with CMS regulations, reimbursement guidelines, and healthcare compliance requirements
Preferred: knowledge of the No Surprises Act and out-of-network reimbursement methodologies

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility