CVS Health

Client Services Representative

• Own and continuously improve operating processes to ensure predictable, repeatable, and scalable execution.
• Evaluate and establish improvements in work intake and workflows to reduce manual effort and rework.
• Identify and drive automation opportunities that eliminate recurring work and reduce operational burden.
• Develop and coach team members to strengthen ownership, decision-making, and resilience during peak periods.
• Improve colleague engagement by simplifying processes, clarifying ownership, and reducing ambiguity across teams.

Senior Manager, Tech Client Services

Director

• Full ownership of financial performance, including budget attainment, margin improvement, and sustainable membership growth through disciplined revenue optimization, medical cost management, and administrative efficiency
• Set and execute market strategy to improve competitive position, quality outcomes (STARs), network performance, and operational effectiveness
• Serve as the senior executive relationship owner with state Medicaid agencies and regulators; represent plan interests with state officials, legislators, and industry associations
• Ensure full compliance with all federal and state requirements; oversee audit readiness and accountability for regulatory performance
• Lead local product design, bid development, and market intelligence efforts to support profitable growth, including oversight of supplemental benefits and delegated vendor partnerships
• Strengthen provider, community, and stakeholder relationships to enhance member experience and provider satisfaction
• Partner with Medicare, Medicaid, Duals segment leadership, and cross‑functional teams (network, clinical, quality, sales, marketing, operations) to deliver integrated results
• Build and develop a high‑performing leadership team; set clear performance expectations and invest in successor and talent development
• Lead readiness and execution for new contracts, programs, and expanded services

Executive Director, DSNP Market Performance

Medical Director

• providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy
• transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in the Medicare and commercial environments, with emphasis on Medicare clinical and payment policy
• participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services
• apply clinical, coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
• proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services
• be a subject matter expert, internal consultant and payment policy contributor
• work collaboratively with the functional areas

Medical Director – Medical Policy & Operations

Procurement

• Execute transactional to moderately complex sourcing events using standardized digital tools and workflows in direct support of defined category strategies and objectives
• Prepare and own RFx materials, scopes of work, and evaluation criteria aligned with enterprise governance and best practices, informed by category insights, demand drivers, and market context
• Lead supplier communications, evaluations, and negotiations, leveraging market and category knowledge to achieve compliant, value‑optimized outcomes that support ongoing category optimization and value realization
• Analyze spend, supplier performance, contracts, and proposals to inform sourcing decisions and category strategies
• Identify trends, risks, and value opportunities that support procurement transformation
• Develop clear, executive-ready analyses that translate complex data into actionable insights
• Support adoption of new sourcing processes, reporting tools, and digital capabilities
• Contribute to process standardization and continuous improvement to enable scalability across categories
• Collaborate with cross‑functional partners to align sourcing activities with enterprise priorities, and present sourcing strategies, insights, and outcomes to business stakeholders to support informed decision‑making

Senior Sourcing Analyst

Compliance

• Support research and review of compliance related matters by gathering facts, organizing information, and summarizing findings
• Assist with responses to inquiries from regulatory agencies
• Prepare and maintain monthly reporting
• Monitor compliance activities to help identify, track, and report trends

Senior Analyst – Regulatory Compliance

Manager

• Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval.
• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Case Manager, Registered Nurse – Field

Data Scientist

• Enhancing claim and appeal operation
• Driving innovation through data science application
• Leveraging analytics for efficiency and accuracy
• Engaging with stakeholders to define data science solutions
• Leading and guiding junior data scientists
• Developing algorithms and predictive models
• Utilizing statistical techniques for insights
• Communicating analytical results using data visualization techniques
• Documenting project objectives and results

Lead Data Scientist

Product Manager

• Manage a mix of senior stakeholders to align on priority and goals, balancing interests across various stakeholders
• Conduct user research, SME interviews, and cross functional stakeholder alignment to align on business needs and requirement
• Develop functional requirements, acceptance criteria, and detailed product specifications to communicate feature requirements to data science, engineering and stakeholder teams
• Support engineering and data science teams to implement features by clarifying requirements, facilitating squad ceremonies, and helping technical team members ground on users and business needs
• Manage product backlog, facilitate problem solving, scoping, and prioritization
• Run day-to-day planning and ceremonies, and champion Agile practices
• Clarify and coordinate dependencies with other teams and stakeholders
• Define, monitor and analyze user feedback and product performance metrics, identifying opportunities for improvement and optimization
• Work with end-users, stakeholders, and leadership to continuously evolve the product roadmap
• Demonstrate and support dissemination of best practices for product ways of working and champion change management

Senior Product Manager – AI and Analytics

Analyst

• Utilizes critical thinking and judgment to collaborate and inform the case management process.
• Facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components.
• Consults with case managers, supervisors, Medical Directors to overcome barriers to meeting goals.
• Identifies and escalates quality of care issues through established channels.

Analyst, Case Manager – Field

• Utilizes critical thinking and judgment to collaborate and inform the case management process.
• Facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling.
• Identifies and assists with accessing benefits and education for members through the use of care management tools and resources.
• Conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives.
• Identifies and escalates quality of care issues through established channels.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes.

Analyst, Case Manager

Operations

• Execute the enterprise SRE strategy, including SLOs, SLIs, error budgets, and reliability roadmaps.
• Establish reliability standards and practices across the applications, backend services, APIs, data platforms, and AI workloads.
• Drive a culture of reliability-by-design and operational excellence across engineering teams.
• Lead adoption of AIOps capabilities for proactive issue detection, alert noise reduction, and predictive failure prevention.
• Partner with the AI Platform team to integrate LLMs and ML models into operational workflows (log summarization, anomaly detection, remediation).
• Own enterprise observability strategy across metrics, logs, traces, and user experience monitoring.
• Lead enterprise incident response, escalation, and post-incident learning (blameless postmortems).

Senior Manager – RunOps

Full-stack Engineer

• Design, develop, and enhance claims adjudication, pricing, and payment‑related mainframe applications
• Build and maintain COBOL programs supporting claim intake, edits, pricing, provider payment, and adjustments
• Develop and support CICS online transactions and high‑volume batch processing flows
• Implement business rules aligned with claims policy, benefits, reimbursement, and payment integrity logic
• Perform impact analysis for benefit changes, regulatory updates, and claim rule modifications
• Conduct abend analysis, root cause analysis (RCA), and defect remediation
• Partner with Operations and Application Support teams to meet SLA, SOX, and audit requirements
• Support release validation, checkouts, and production cycles for claims systems
• Optimize DB2 SQL for claims queries, extracts, and payment calculations
• Tune batch jobs and job streams to improve cycle time, batch window adherence, and CPU efficiency
• Identify and resolve data integrity issues impacting claim outcomes and provider payment
• Support integration of mainframe claims platforms with downstream and upstream systems (vendor feeds, pricing engines, clinical edits)
• Participate in modernization initiatives such as service enablement, API exposure, and hybrid cloud integrations
• Mentor junior engineers and support consistent engineering standards

Senior Software Development Engineer

Sales

• The Salesforce Data360 Lead Architect plays a critical role within the Salesforce Enablement & Operations (SEO) organization, providing architectural leadership for the enterprise adoption of Salesforce Data360 (formerly Data Cloud)
• This role serves as the design authority for Data360 implementations, ensuring solutions are secure, scalable, compliant, and aligned to Center of Excellence (CoE) standards and Enterprise Data Governance policies
• The Lead Architect partners with Salesforce delivery teams, Enterprise Architecture, Data Governance, Security, and Platform Operations to define architecture patterns, review designs, and guide teams from proof‑of‑value efforts into enterprise‑grade, reusable capabilities
• This role balances hands‑on design leadership with strategic oversight, enabling trusted data foundations that power analytics, activation, and AI‑enabled use cases (including Agentforce)

Salesforce Data360 Lead Architect

• responsible for development and delivery of technology solutions for compliance and audit management
• apply deep technical expertise to design and operationalize technology solutions
• develop robust, audit-ready control environments
• automate evidence collection for modern technology stacks
• collaborate with cross-functional teams to ensure alignment and execution of compliance program

Staff Engineer – Regulatory Technology

Data Engineer

• Build and optimize analytical data models in BigQuery
• Implement partitioning, clustering, and materialized views for performance and cost efficiency
• Ensure compliance with data governance, access controls, and IAM best practices
• Develop integrations with external systems using GCP-native or hybrid approaches
• Utilize tools like Dataflow or custom Python/Java services on Cloud Functions or Cloud Run
• Build automated CI/CD pipeline using Cloud Build, GitHub Actions, or Jenkins
• Set up observability using Cloud Monitoring, Cloud Logging, and Error Reporting