CVS Health

Data Engineer

• Design, develop, and maintain scalable cloud-native data pipelines and microservices (GCP preferred; Azure/AWS acceptable)
• Build and optimize data ingestion, integration, and processing frameworks across diverse structured and unstructured data sources
• Develop Python-based APIs (Flask/ FastAPI ) to enable seamless data access, model integration, and service orchestration
• Implement advanced SQL-based analytics and transformations in BigQuery or other cloud data warehouse platforms
• Architect, deploy, and manage AI/agentic workflows to support intelligent automation and decisioning
• Orchestrate AI-driven pipelines integrating LLMs, agents, and data services for end-to-end workflow automation
• Drive automation and continuous improvement of data operations using AI-powered orchestration and monitoring
• Collaborate with cross-functional teams (Data Science, ML, and Product) to deliver scalable, secure, and production-grade AI-enabled data solutions

Senior Data Engineer

Consultant

• Dealing with health plan data and trends can be unfamiliar territory for Meritain Health's clients.
• In collaboration with Meritain's Client Solutions Team we leverage analytics tools to evaluate quantitative and qualitative data.
• Informatics focuses on translating this data into comprehensive insights and actionable results for our employers.
• Proactively offer insights on client plan performance with a focus of turning data into actionable information.
• Effectively communicate and collaborate across departments to manage client and broker requests for your block of business.
• Become a subject matter expert for Client Management, clients and brokers related to our internal analytics tool and their client's data.

Informatics Consultant

Manager

• Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
• Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work
• Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care
• Communicates with member/client and other stakeholders as appropriate
• Prepares all required documentation of case work activities as appropriate
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
• Provides educational and prevention information for best medical outcomes
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes

Case Manager RN, Compact License

Pharmacist

• Support pharmacy team in delivering operational and service excellence
• Assist pharmacy team to ensure that pharmacy operations run smoothly
• Demonstrate genuine care and contribute to a safe and inclusive culture
• Complete a rigorous company training program and satisfy all registration, licensing, and certification requirements

Pharmacy Technician

Executive Assistant

• Provides executive administrative support services
• Scheduling coordination, document preparation and distribution
• Coordinates meetings and makes travel arrangements
• Resolves complex inquiries and ensures smooth office operations
• Monitors status of delegated items to ensure closure

Scrum Master

• Develop agile based SDLC/APLC for new software development organization creating necessary standards, tools and best practices in a clearly documented form.
• Participate and support initial development pilots during the initial phases of the project.
• Organize and facilitate project planning, daily stand-up meetings, reviews, retrospectives, sprint and release planning, demos and other Scrum-related meetings.
• Track and communicate team velocity and sprint/release progress.
• Maintain process documentation.
• Ensure the development teams are practicing the core agile principles of collaboration, prioritization, team accountability, and visibility.
• Update agile tracking systems to provide transparency on Product & Sprint Backlogs.
• Recommend improvements and assist in changes to best practice.
• Support the development managers and project leads as necessary.
• Assist with internal and external communication, improving transparency, and radiating information.
• Assist team with making appropriate commitments through story selection and task definition.
• Identify and remove impediments, prevent distractions that interfere with the ability of the team to deliver the sprint goal.
• Facilitate discussion and conflict resolution.
• Empower the teams to self-organize
• Improve the productivity of the teams in any way possible.
• Ensure the team strives to make each increment of functionality potentially shippable.
• Participate in the organization and planning of the development schedule based on methodology that has been developed to create a cohesive plan with identifiable critical path, task dependencies, and major milestones, and manages the agreed project plans and schedules, ensuring successful completion within scope, budget, time, and quality parameters.
• Adapt project plans, schedules, and resource assignments as required throughout pilot projects to respond to emerging requirements and risks.

Manager – Scrum Master

Medical Billing and Coding

• Perform medical claim reviews for the Special Investigations Unit (SIU)
• Conduct a comprehensive medical record audit to ensure compliance with coding practices
• Provide detailed written summary of medical record review findings
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
• Research and accurately apply state or CMS guidelines related to the audit
• Review and discuss cases with Medical Directors to validate decisions
• Assist with investigative research related to coding questions, state and federal policies
• Identify potential billing errors, abuse, and fraud
• Identify opportunities for savings related to potential cases which may warrant a prepayment review
• Maintain appropriate records, files, documentation

Analyst, SIU Certified Coder

Customer Support

• Creates an emotional connection with our members by understanding and engaging the member to the fullest.
• Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
• Anticipates customer needs.
• Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
• Explains member's rights and responsibilities in accordance with contract.

Customer Service Representative – Behavioral Health

• Ensure timely and accurate billing for outstanding claims
• Demonstrate excellent customer service to patients, healthcare professionals and insurance carriers
• Work in a fast paced and team focused environment to ensure timely and accurate billing to insurance providers
• Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors
• Maintain patient demographic and insurance information and data collections systems
• Research and respond to insurance companies regarding billing issues or related questions

Medical Billing Coordinator – Revenue Cycle

• responsible for designing, developing, and delivering data and reporting solutions that support care management operations and population health strategies
• partners with clinical and operational stakeholders to translate business needs into scalable data assets, dashboards, and analytics that enable performance tracking, identify gaps in care, and improve program outcomes
• ensures data accuracy and consistency across claims, clinical, and vendor sources, and produces actionable insights to inform decision-making, enhance care management effectiveness, and drive continuous operational improvement

Senior Manager, Informatics

• Perform audits of provider‑related data, and financial arrangements to validate compliance with contract terms, internal policies, and regulatory requirements
• Review and assess documentation, calculations, data sources, and system outputs related to Medical Economics processes
• Independently identify audit exceptions, root causes, and risk levels, ensuring findings are supported by clear evidence
• Apply defined audit criteria, scoring methodologies, and sampling approaches consistently across audits
• Serve as a primary audit point of contact within MEU for provider groups, delegated vendors, and network partners when audit activity requires external coordination
• Communicate audit scope, findings, and remediation expectations clearly and professionally to external providers and internal network teams
• Document audit results, findings, and remediation actions in audit tools, trackers, and workpapers with a high level of accuracy and clarity
• Track findings through remediation and verification, escalating risks and delays as needed

Manager, Medical Economics

Data Scientist

• Independently solves complex, ambiguous business problems and brings new perspectives to existing solutions across operational, financial, and clinical domains.
• Structures and leads advanced analytical and AI-driven approaches to address high-impact business challenges.
• Partners closely with business stakeholders to understand objectives, constraints, and success metrics.
• Acts as an analytics product owner by defining problem statements, shaping solution approaches, prioritizing workstreams, and driving measurable business outcomes.
• Leads development of moderately complex solutions with meaningful business risk and visibility.
• Develops and delivers executive-ready presentations that clearly communicate technical findings, trade-offs, and recommendations to senior leadership and client-facing teams.

Senior Data Scientist – AI

• Support the pharmacy team in delivering operational and service excellence within your store
• Assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately
• Demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered
• Complete a rigorous company training program and satisfy all registration, licensing, and certification requirements according to their State’s Board of Pharmacy guidelines
• Show empathy and genuine care during customer interactions
• Comply with CVS policies and procedures to ensure patient safety, compliance with controlled substance dispensing and recordkeeping, and to protect patient privacy and security

• design, develop, and maintain enterprise-grade dashboards using Tableau
• develop and optimize BigQuery-based datasets and views to support scalable analytics and reporting
• apply best practices in data modeling, query optimization, and dashboard performance tuning
• partner with business stakeholders to translate requirements into scalable analytics solutions
• ensure efficient use of GCP resources through optimized query design and data partitioning strategies

Manager, Business Reporting and Analytics

• The Case Manager RN is responsible for telephonic and/or face‑to‑face assessment, planning, implementation, and coordination of case management activities for members
• The role evaluates members’ medical needs to promote overall wellness, improve short‑ and long‑term outcomes, and support appropriate, cost‑effective care delivery aligned with Aetna/CVS Health benefit plans and clinical policies

Senior Data Engineer

Informatics Consultant

Case Manager RN, Compact License

Pharmacy Technician

Executive Assistant

Manager – Scrum Master

Analyst, SIU Certified Coder

Customer Service Representative – Behavioral Health

Medical Billing Coordinator – Revenue Cycle

Senior Manager, Informatics

Manager, Medical Economics

Senior Data Scientist – AI

Pharmacy Technician

Manager, Business Reporting and Analytics

Registered Nurse Case Manager – LTSS