CVS Health

Director

• responsible for driving strategies to advance financial performance and profitability for both clients and the PBM organization
• identify opportunities and leverage matrix partners to develop innovative strategies effectively and efficiently
• deliver actionable insights to Trade Value Strategy Leadership and the broader Trade organization
• identify and evaluate strategies to optimize client value in response to pharmaceutical market events
• collaborate with other PBM functional areas to assess various trade and formulary strategy initiatives, with the goal of improving client net costs
• communicate analytical results and insights to senior business leaders
• develop or enhance processes and reporting to understand and drive management of rebate and margin impacts
• assess pharmaceutical industry trends to develop relevant insights and determine potential implications on future rebate value
• collaborate with Trade Relations, Formulary Strategy, and Trade Finance teams to investigate opportunities to optimize rebate value
• serve as cross-functional partner to other business functions to assess and align on the impact of market events, policy changes, and trade strategies
• promote development of team members through coaching, training, and leadership opportunities

Lead Director, Trade Industry Analysis

Analyst

• Analyzes service center trends, including volumes, arrival patterns, staff productivity and resource allocation

Analyst, Workforce Management

Manager

• Plans, monitors and manages internal projects from initiation through completion
• Secures required resources and uses formal processes and tools to manage resources, budgets, risks and changes
• Manages projects to ensure on-time completion according to specifications and within budgeted costs
• Act as a top-level specialist on project management and develop comprehensive plans
• Ensure alignment on key deliverables and timelines
• Analyze business documentation to ensure accurate and complete responses to auditor/regulator
• Ensure operational processes are aligned with regulatory and organizational requirements
• Oversee operational key performance indicators to measure progress
• Create a continuous improvement environment
• Effectively manage multiple audits and projects and respond to change with adaptability

Senior Manager, Audit and Business Oversight

• Conduct high level investigations of known or suspected acts of healthcare fraud and abuse
• Handle high profile or highly sensitive matters involving cases with multiple subjects, or intricate healthcare fraud schemes
• Conduct state specific investigations for Louisiana for program integrity to prevent payment of aberrant claims submitted to the Medicaid lines of business for payment
• Conduct thorough research on subject(s) and related entities
• Initiate independently proactive data mining using SIU Tools to identify aberrant billing patterns and early scheme detection
• Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme
• Research and prepare cases for both clinical and legal review
• Collaborate with Medical Directors on clinical issues and medical record questions
• Accurately documents all case activity and communications in designated case tracking system
• Communicate clinical findings to provider
• Adhere to all regulatory requirements
• Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing
• Collaborate with federal, state, and local law enforcement agencies for the investigation and prosecution of healthcare fraud issues
• Communicate clearly a high level of FWA knowledge and understanding during interactions with both internal and external stakeholders

Analyst, Special Investigative Unit

IT Support

• Assist our members who have questions tied to our mobile application and website
• Provide support via telephone or directly from the application
• Resolve many member issues during the initial call
• Escalate a smaller percentage of issues to another department for resolution
• Keep the member informed of progress and the resulting resolution
• Track all tickets and their related documentation in Service Now

Senior Help Desk Support Specialist

• Develop an expert level understanding of Signify’s core product offerings and analytics technology
• Write complex SQL queries to extract data from large databases for analysis and predictive modeling
• Provide clinical insights through analyzing data including HCCs, Claims (ICD10, CPT, POS, etc), and HEDIS measures
• Define, track, report out, and explain metrics representing the value of the product
• Develop ad hoc analysis, dashboards, and visualizations to help non-technical consumers easily understand data correlations
• Ensuring data accuracy, integrity, and compliance with regulations like HIPAA
• Deliver defined HCS Clinical Analytics work on time and with high quality
• Communicate and Coordinate regularly with stakeholders to execute strategic priorities
• Other responsibilities as required to ensure company success.

Senior Analyst, Business Analytics

Program Manager

• Reporting to the Executive Director of Revenue Integrity (RI), the Lead Director – Revenue Integrity (Medicaid) is responsible for driving segment-level performance across Medicaid risk adjustment and revenue integrity initiatives.
• Leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment.
• Partners closely with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets.
• Plays a critical role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with enterprise revenue integrity strategy.

Medicaid Risk Adjustment Lead Director

Consultant

• Provide subject matter expertise, analytical support, and delivery enablement for Medicaid Provider Directory operations
• Partner across business, IT, and compliance teams to translate regulatory, operational, and platform requirements into actionable outcomes
• Support data integrity, compliance readiness, delivery quality, and overall operational stability through proactive risk identification and resolution
• Analyze platform functionality and data to support business and technical decision-making
• Conduct gap analyses and assess impacts of regulatory or policy changes
• Partner with stakeholders to intake, clarify, and refine requirements
• Collaborate with Product Owners, BAs, and IT teams to ensure delivery readiness
• Define test scenarios and expected outcomes for directory changes

Manager, Business Consultant

Production Engineer

• Own and evolve production operations strategy for AI/ML platforms and services
• Define SLOs, SLIs, and error budgets for AI systems
• Lead root cause analysis (RCA) and drive systemic improvements post-incident
• Establish operational readiness standards for launching new AI capabilities
• Build frameworks for on-call excellence , incident response, and escalation
• Design and implement end-to-end observability systems across AI workloads
• Implement model observability (drift detection, data skew, performance degradation)
• Build internal platforms and tooling for automated incident detection and response
• Mentor senior engineers and influence cross-team architectural decisions

Principal Software Engineer – AI Platform, Production Engineering, Reliability

• Partner with the Tax Leadership team to shape indirect tax strategy
• Stand up scalable indirect tax processes for emerging or evolving business models
• Lead change management for new processes and solutions
• Identify indirect tax risks and opportunities associated with new business activities
• Build cross-functional partnerships to gather requirements
• Create repeatable playbooks, templates, and governance rhythms
• Influence outcomes through expertise and relationships

Manager, Indirect Tax Strategy and Planning

• Assessing, planning, implementing, and coordinating all case management activities with members.
• Managing a caseload that includes supportive and medically complex members.
• Developing a proactive course of action to address issues presented to enhance member's overall wellness.
• Determining appropriate services and supports due to member's health needs.

Bilingual Analyst, Case Management

• Drive Strategy & Alignment
• Partner with Medicaid business and digital leaders to define, align, and advance digital priorities
• Connect stakeholder needs, member insights, and business goals into clear, actionable strategies
• Ensure all work is aligned to Medicaid digital strategy, enterprise priorities, and member experience outcomes
• Own Stakeholder Engagement
• Serve as the single point of contact across business, product, technology, and operations teams
• Build strong, trusted relationships and ensure stakeholders are informed, aligned, and engaged
• Act as the bridge between strategy and delivery—ensuring clarity and continuity across teams
• Manage Intake with Precision
• Own the end-to-end intake process for Medicaid, from submission through prioritization and readiness
• Ensure all work is documented, and aligned to strategic goals and roadmap priorities
• Maintain a clear and transparent pipeline of work tied to business value and impact
• Enable Execution & Delivery
• Track initiatives from intake through delivery, ensuring alignment to timelines, milestones, and strategic outcomes
• Provide clear, concise updates on progress, risks, and dependencies
• Proactively identify and resolve gaps to keep work moving forward
• Create Structure in a Fast-Paced Environment
• Bring organization and discipline to complex, fast-moving workstreams
• Maintain centralized trackers, documentation, and communication artifacts
• Continuously improve processes to drive efficiency, clarity, and execution excellence

Medicaid Digital Stakeholder Manager

• Assess, plan, and coordinate care for members telephonically and virtually
• Develop proactive care plans to improve short‑ and long‑term health outcomes
• Use clinical judgment and data insights to address complex medical and social needs
• Support smooth transitions across care programs and benefits
• Collaborate with multidisciplinary teams to remove barriers and optimize care
• Engage members through effective interviewing and education to support wellness

Case Manager – Registered Nurse, Illinois RN License

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to ABA.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

ABA UM Clinical Consultant

Product Manager

• Partner with multiple Product Owners and Product leadership team right from the ideation phase to mature the product concepts and helps them with IT evaluation exercise (SWAT)
• Work with multiple IT and business areas to develop IT solution, strategy, MVP (Minimum Viable Product and provides the IT Guidance ranges/cost estimates
• Coordinate release planning, oversees delivery milestones, resolves issues, and removes the barriers that may hinder project execution
• Proactively evaluates all work that is in flight, builds contingency plans, and executes corrective action on a timely basis to mitigate risks such as scope and/or budget variances
• Ensure that projects/enhancements align with the Commercial Product delivery objectives by thoroughly understanding the business segment's drivers and issues
• Identify and leverage project interdependencies to ensure synergy between the projects and to promote benefits realization across the portfolio.