CVS Health

Claims Specialist

• Review pharmacy claims submitted through the CVS Health claims processing systems
• Identify and rectify claim inaccuracies that would result in client over-payment
• Contact pharmacies for proper documentation to ensure a claim was submitted correctly
• Monitor assigned clients and report status on a regular basis
• Follow the appropriate policies in the event of an inaccurate claim submission

Pharmacy Technician – Claims Analyst

Manager

• Collaborate with Product Managers to define strategy, conduct market research, and maintain an aligned roadmap
• Engage with executives and teams, balancing priorities and negotiating solutions
• Partner with designers, developers, and business leaders to drive successful product delivery
• Champion user needs, foster engagement, and refine products based on data-driven insights
• Prioritize development efforts, write clear user stories, and track performance metrics
• Ensure security standards, regulatory adherence, and proactive risk management
• Lead cross-functional collaboration for complex efforts, ensuring alignment across teams
• Collaborate with third-party vendors, ensuring seamless integration
• Evaluate product performance in terms of revenue, cost, and operational efficiency
• Lead adoption strategies and provide user support for new features and solutions
• Mentor peers in execution best practices and optimize workflows for scalability and impact

Digital Product Manager

Business Intelligence Analyst

• Develop reports in SQL and SAS.
• Review MCO/Client Requests with internal and external partners to translate them into clear business requirements.
• Build relationships with Account Teams, Legal, Compliance, Client Audit, Finance Operations, and others, by providing reporting leadership representation.
• Continuously evaluate/evolve processes, best practices, and tools around data, reporting, and automation.
• Ensure the accuracy and quality of the deliverables, applying high standards for quality control to all reporting and analytic work.
• Ensure consistent and clear documentation for production-ready reporting solutions.
• Handle, communicate, and escalate issues (as needed) in a timely manner so as not to impact delivery.
• Lead by example to inspire a positive attitude, engagement, and professional growth.
• Proactively lead reporting & automation activities, tracking completion of action items, resolving issues, and mitigating risk.
• Champion a culture of continuous improvement, curiosity, collaboration, and innovation.
• Constantly work to understand data structures and their business context.
• Negotiate and document requirements, agreements and changes with business users.

Senior Reporting Analyst

Director

• Act as the Solution Owner of a complex, matrixed workstream partnering closely with cross-functional leaders and serving as a leader of the supporting cross-functional business and DDAT team.
• Guide the design, build, and launch of the workstream features and supporting API, ensuring alignment with PBM business needs and client expectations.
• Serve as a primary business voice in shaping requirements, prioritizing features, and driving delivery timelines.
• Foster collaboration among business, technology, product, and process engineering teams.
• Bring deep understanding of PBM processes, client events, and the operational realities of the PBM business.
• Anticipate and address client strategy, pricing strategy, regulatory, and compliance requirements throughout the development lifecycle.
• Establish processes and performance metrics to ensure the workstream delivers on its intended value
• Develop and maintain documentation, governance, and change management plans to support sustainable adoption
• Guide maintenance, future enhancements, roadmap planning, and integration of evolving PBM business strategy and technology needs
• Own ongoing stakeholder engagement, issue resolution, budget management and performance monitoring
• Clear bias for action to iterate and deliver value while aligning to the north star vision
• Bring a consultative perspective and recommendations to department leaders with an eye toward how digital transformations may require them to adjust their business models
• Enable data-led decision making by leveraging existing data, creating new metrics where necessary and ensuring we activate the data to inform and serve our customers and business.

Lead Director, Solution Management

Administration

• Responsible for supporting the loading of new and revised Medicaid participating provider data transactions into Aetna/CVS source systems
• Daily activities include provider data service, supporting data compliance and directory alignment within QNXT
• Handle tickets and cases coming in from providers
• Proactively define, identify and recommend process enhancements or modifications
• Meet and support established departments productivity, quality, and compliance metrics
• Perform data compares and work with Large Data Sets
• Follow area protocols, standards, and policies to provide effective and timely support
• Attend required department trainings to support learning

Provider Data Services Administrator

Actuary

• Provides strategic direction in support of the organization's business goals and financial integrity
• Collaborates with business partners to provide sound risk management advice
• Lead the development of pricing strategies that align with CVS Caremark’s overall business objectives and market positioning
• Identify opportunities for innovative pricing approaches that enhance profitability and competitiveness
• Work closely with the underwriting team to develop and integrate pricing strategies that reflect the organization’s objectives
• Work with business partners to identify trends and opportunities for differentiation
• Leverage data analytics to assess assumptions setting the effectiveness of pricing strategies
• Monitor key performance indicators (KPIs) to evaluate the impact of pricing initiatives
• Develop and implement new pricing models that drive value for both CVS Caremark and its clients
• Collaborate with various departments, including sales, marketing, finance, and operations
• Present pricing strategies and recommendations to senior leadership and key stakeholders
• Ensure that all pricing strategies comply with relevant regulations and industry standards

Senior Manager, Actuarial Services

Consultant

• Designing, auditing, and releasing ID cards for printing and mailing.
• Programming information that will print on a client’s ID cards – customizing as requested.
• Using plan documents to determine what information to put on ID card and manually enter that into the vendor system.
• Work cross functionally to understand unique client requests/needs and work that into the best layout option.
• Auditing live cards against approved samples and correcting problems.
• Completing daily and monthly tracking using Excel and Salesforce.
• Working on process improvements, user testing, and updating existing client setups.

Eligibility Consultant – Electronic

Analyst

• Negotiate out-of-network (OON) medical claims valued at $10,000 and above
• Learn the negotiation role and understand (U&C) calculated rates and benchmarking of medical costs
• Develop role as a negotiator, working with training staff and team members
• Conduct checklist workups and manage outbound communications via phone, fax, and email to facilitate negotiations
• Work up and organize daily cases
• Make outbound calls and develop provider contacts

Negotiator Analyst, Level I

• Define the platform product vision and multi-year roadmap aligned to enterprise digital and AI strategy
• Clearly articulate what is a shared platform vs. domain-specific capability
• Establish platform positioning as build once, consume everywhere
• Balance innovation with stability and backward compatibility
• Own end-to-end product accountability for shared platforms
• Product discovery and requirements
• Roadmap prioritization
• API and capability definition
• Adoption and lifecycle management
• Partner with engineering teams to deliver scalable, secure, reliable platform capabilities
• Ensure platforms are consumer-grade for internal teams
• Drive enterprise adoption of shared platforms across channels
• Reduce duplication by deprecating overlapping or bespoke solutions

Executive Director, Digital Platform Products

• Analyze and explain national and state medical cost trends using various data sources.
• Build strong partnerships with Finance, Actuarial, Market, and Compliance leaders.
• Develop new reports, exhibits, and presentations for recurring internal and external meetings.
• Stay informed about economic, demographic, and regulatory factors that influence Aetna’s costs.
• Support enterprise initiatives aimed at reducing medical cost pressures.
• Use tools like SQL, GCP, VBA, R, SmartView, ThoughtSpot, and Microsoft Office to improve reporting and processes.
• Help implement new technologies, including the ADAM cloud platform and daily claims data tools.
• Present complex data in a clear, executive‑friendly way to senior leaders.

Senior Actuary – Cost Growth Benchmarking

• Lead and close deliverables related to department initiatives and PA activities in a timely manner
• Support CAPAS service catalog offerings
• Maintain CAPAS service-related job aids and documentation
• Drive innovative improvements across CAPAS operations
• Validate functionality of new programs and innovations
• Support implementation of client PA files during the clinical review portion of member data transitions
• Assist partners in understanding adjudication claim processing
• Provide training and cross-training to internal CAPAS team members, including new hires and advanced deep-dive sessions

Manager, Clinical Adjudication – Prior Authorization Solutions

Designer

• Independently leading dozens of partners across Product, Operations, Medical Affairs, Legal, Sales, Account Management, Data Science & Engineering, IT, Client Analytics to structure and execute on new product designs and enhancements
• Partner with Marketing, Sales, and Account Management to commercialize our products and communicate product performance and our product roadmap
• Build business cases to justify and prioritize product enhancements and design a measurement strategy to measure their impact
• Define longitudinal patient journeys that meet engagement and clinical outcomes, write requirements, and then partner with Operations and Technical stakeholders to bring these experiences to life
• Evaluate KPI and SLA performance, measuring product efficacy to formulate and subsequently deliver upon quality improvement plans
• Leverage data-driven insights and a deep understanding of patient and client needs and market dynamics to identify and prioritize enhancements
• Conducting deep dive quantitative and qualitative analyses to identify opportunities for innovation and process improvement

Senior Manager, Product Strategy and Design

Full-stack Engineer

• Communicate with business leaders to help translate requirements into functional specification
• Develop broad understanding of business logic and functionality of current systems
• Analyze and manipulate data by writing and running SQL queries
• Analyze logs to identify and prevent potential issues from occurring
• Deliver clean and functional code in accordance with business requirements and adhering to established SDLC best practices
• Consume data from any source, such as flat files, streaming systems, or RESTful APIs
• Interface with Electronic Health Records
• Engineer scalable, reliable, and performant systems to manage data
• Participate in code reviews, contributing constructive feedback to peers and integrating feedback into your own work
• Collaborate closely with other Engineers and Product Manager in your team as well as across the organization

Software Development Engineer

• Design and conduct analyses to validate, refine, and develop key business assumptions
• Define and standardize methodologies, while establishing process for ongoing review and refresh cycles
• Gain a comprehensive understanding of business processes and systems
• Work with business teams on appropriate execution strategies for implementing assumptions
• Communicate analysis findings and recommendations to managers, supervisors, and individual contributors
• Review and interpret data models, making recommendations for planning, forecasting, and reporting
• Anticipate and recognize issues that materially affect financial results, making recommendations on these matters
• Provide support for broader actuarial priorities, such as ad-hoc analyses and strategic projects

Manager, Actuarial

Engineering Manager

• Engineer highly scalable, distributed web services & applications
• Work on enterprise services and applications
• Be responsible for the security and privacy of all protected health information that may be accessed during everyday work activities
• Deliver high-quality code to production
• Suggest paradigms, toolsets, frameworks, or third party solutions and work to establish consistency in terms of process and approach.
• Support team members and drive: Partnership with and execution of product direction across the group.
• Adoption of new technology and best practices.
• Fostering a security mindset, helping to train and implement code security best practices within the team.
• Aggregating and reviewing engineering performance and application uptime KPIs.
• Strong mentorship and coaching to junior software engineers leading software design and implementation of most projects.
• Identifying opportunities for improvement across dependent services and teams.