CVS Health

Data Entry

• Coordinates data entry support activities to assist in ensuring organizational reporting objectives are met.
• Conducts data entry and data verification tasks to facilitate administrative operations and information management/retrieval processes.
• Follows established procedures while working under general supervision to complete routine support tasks.
• Develops effective relationships with all team members to promote a collaborative work culture.
• Enters alpha and numeric data using key-to-disk standalone equipment, PCs, and other data entry terminals.
• Maintains and demonstrates a functional knowledge of data entry devices, applications, job formats, and system commands.
• Ensures data accuracy by cross-referencing data with physical documents and/or communicating with healthcare providers to clarify any discrepancies or missing information.

Data Entry Operator

Full-stack Engineer

• Build and deploy using GitHub, CircleCI, Harness as part of CI/CD process in leading Cloud Platforms - AWS, GCP or Azure etc
• Continuously check and monitor App health and KPIs, support triage of any production issues as and when needed
• Partner with application owners, business partners and peer groups regarding long and short-range technical solutions that meet business requirements
• Analyze and contribute to project and business requirements based on product team milestones and priority
• Actively participate in Agile Scrum team activities including Sprint Planning, Grooming, Scrum, Reviews and Retrospectives
• Leverage expertise to design and implement efficient and scalable solutions that meet business requirements and quality standards
• Contributes to solution design and architecture discussions, collaborating with architects and senior engineers
• Provide input on technical feasibility, performance optimization, and scalability considerations to ensure that the overall solution meets the desired objectives
• Participate in code reviews and ensures adherence to coding standards, best practices, and quality guidelines
• Communicate and coordinates with team members to ensure alignment, provide technical insights, and contribute to decision-making processes
• Contribute to the adoption of best practices, new technologies, and tools to enhance productivity, efficiency, and code quality
• Participate in knowledge sharing activities, such as code reviews, tech talks, and workshops, to foster a culture of learning and collaboration within the team
• Work with other developers and team members to implement complex features, enhance existing functionality, and ensure the delivery of high-quality code
• Provide guidance and mentorship to junior developers, helping them improve their technical skills and grow professionally

Staff Software Development Engineer

Manager

• Drive strategic problem solving, opportunity analyses & new idea generation for initiatives within the Specialty Care team at Oak Street
• Manage detail-oriented programs with extensive data needs & stakeholder engagement
• Drive critical business analytics – interest in learning new programs and skills, and strong analytical chops
• Engage frequently with field care teams to understand pain points in our current workflows, creatively problem solve, train team members on new processes, and ultimately drive utilization of our Preferred Networks to improve patient care
• Partner with the Product and Engineering teams on problem solving, idea generation, and issue tracking
• Manage third party vendor relationships
• Create metrics and reports to monitor success of programs and identify opportunities for improvement
• Identify and implement opportunities to improve efficiency of workflows and overall project development

Population Health Manager – Specialty Care, Performance Improvement

Claims Specialist

• Prepare, update, and submit stop loss filing packages, including initial, subsequent, and year-end filings as needed
• Track claim activity and follow up through to completion with stop loss carriers and other stakeholders to help ensure reimbursements are received accurately and timely
• Monitor assigned employer groups and clients using reports, analysis, and reimbursement activity trends
• Assist in researching and reconciling discrepancies between requested reimbursement amounts and amounts returned by stop loss carriers
• Serve as an advocate for clients by helping capture the maximum eligible reimbursements available under applicable stop loss policies
• Review claim documentation for completeness, accuracy, and alignment with policy provisions and filing requirements
• Research and resolve cases that require additional analysis, documentation, or explanation
• Communicate with internal and external stakeholders to obtain information, resolve issues, and support timely filing resolution
• Partner with cross-functional teams, including areas such as underwriting, finance, eligibility, and client support, to facilitate filing resolution
• Maintain accurate records, logs, and supporting documentation related to assigned stop loss filings and reimbursements
• Escalate complex issues or delays appropriately and support process improvement efforts when trends or gaps are identified

Stop Loss Claims Analyst

Implementation Specialist

• play an instrumental role in helping to strengthen our Medicare Telesales organization
• responsible for coordinating and implementing all initiatives through end-to-end program oversight across Internal and Vender Telesales operations
• coordinate cross functionally to ensure processes are implemented to achieve key performance expectations
• present and consult with mid and senior management on business trends to develop new and enhanced processes
• track all business activities pertaining to the Internal and Vender Telesales program for further optimization
• analyze progress of initiatives to implementation
• coordinate routine review of business processes and suggest new strategies based on risk and opportunities
• ensure all processes for Internal and Vender Telesales are appropriately documented and up to date for reference across Telesales
• maintain appropriate documentation of all initiatives
• manage multiple projects including the development, implementation, and closure for assigned projects
• cascade all related meetings across functions
• prepare project status reports, presentations and meeting minutes, where applicable
• set and maintain expectations with key stakeholders with respect to ownership, progress, etc.
• demonstrate clear understanding or legal and privacy requirements for Medicare Telesales business.

Senior Medicare Telesales Implementation Manager

Analyst

• Pursue the recovery and allocation of overpaid dollars, and non-routine and complex refunds
• Manage, monitor, and work overpayment items
• Partner with third-party vendors, research and respond to recovery inquiries
• Make outbound calls to providers; track and conduct follow-ups to recover funds
• Collaborate with key business functions on escalated overpayments to coordinate recovery efforts
• Review, collect, and resolve overpay or recovery conflicting, missing or inaccurate information via telephone or written correspondence
• Partner with internal customers/business units, third party vendors, and liaisons to recover and fully allocate refunds
• Administer overpayment recovery policy and procedures, telephone and written correspondence to members, providers, and other insurers
• Manage overpayment work; collaborate and conduct provider outreach to achieve business goals
• Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures
• Use a systematic approach in solving problems through analysis and evaluation of alternate solutions
• Utilize available reports to track inventory and recovery results
• May deliver recovery training programs for less experienced team members
• Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process
• Performs medical claim re-work calculations
• Process complex non-routine Provider Refunds and Returned Checks
• Review and interprets medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks
• Utilize all resource materials to manage job responsibilities

Recovery Analyst

Consultant

• Quality check complex benefit information, including non-standard plan language into crisp, compliant, easy-to-understand plan language for self-funded plans.
• Analyzing, drafting, editing, and reviewing all legal and regulatory plan documentation for our self-funded plan customers.
• Understanding regulations, laws, and internal procedures impacting self-funded health plans.
• Successfully negotiate deadlines and influence change/enhancement to business processes.
• Deliver high-quality documentation ensuring department standards are met with a focus on correcting errors in spelling, grammar, and formatting before sending to customers.
• May participate in implementation of department projects as needed.

Senior Quality Consultant

• Set and influence strategy for health plan medication adherence solutions
• Identify and evaluate new ideas to improve medication adherence
• Assess and size new opportunities using qualitative and quantitative insights
• Build business cases and recommendations to support investment decisions
• Lead individual workstreams and manage projects from idea through execution
• Partner with cross‐functional teams to align priorities and drive results
• Support development of multi‐year strategic roadmaps
• Prepare clear insights, presentations, and updates for senior leadership
• Track progress and communicate outcomes, risks, and learnings

Manager, Health Plan Adherence Solutions – Strategy and Innovation

Content Writer

• Draft, review, and edit medical, dental and vision plan documents
• Support plan document needs for new business by creating plan documents and summaries of benefits and coverage

Senior Document Writer

Human Resources

• Partner with HR Leadership to develop and execute both long- and short-term strategic plans for PCW.
• Help create and drive a cadence and process by which the team and key business partners measure and review progress against our key priorities.
• Coordinate and drive planning, execution and implementation of HR cross functional, critical, and high impact projects that align to our key strategic pillars.
• Ability to identify key stakeholders and convey knowledge of their business to build trust and understand the leader’s objectives.
• Actively engage key partners in collaborative problem solving to drive decision making.
• Ability to position yourself as a trusted advisor to both HR and business leaders by demonstrating expertise and providing valuable insights on HR matters.
• Partner with analytics teams to create views and routines to ensure the HR team has the data and tools to help monitor progress, assess complex problems, and deliver sustainable solutions.
• Challenge partners to think differently regarding HR and operational issues.
• Help drive colleague engagement across the PCW HR and PCW team by ensuring we have the right touch points and cadence of communications with our colleagues. Help develop and move forward Engagement plans that are rooted in colleague feedback and data to help foster a best-in-class culture.

Lead Director, HR Strategy – Pharmacy & Consumer Wellness

Growth Marketing

• Define our long-range Enterprise growth strategy
• Considering market and consumer trends, define our long-term strategy in partnership with corporate strategy and business segments
• Identify opportunities to make our CVS Health and BU brand positioning clear, differentiated, and defensible in a way that creates ongoing preference and growth
• Always be looking 2-3 years ahead to proactively identify growth opportunities for CVS Health – both at the enterprise level and within each of the Business Segments to drive measurable business impact
• Partner cross-functionally and with BU teams to bring brand strategy to life
• Present points of view on various growth strategy that are rooted in data and insight

Lead Director, Strategy & Growth

• Support the resolution of high-stakes, complex provider issues escalated from executive leadership, regulatory agencies, and legislative offices
• Manage sensitive inquiries from the CEO, COO, OHCA, state legislators, and other key stakeholders
• Support the Senior Manager in serving as a liaison for provider escalations originating from C-suite executives, OHCA, legislative offices, and other high-priority stakeholders
• Act as backup to the Senior Manager, Provider Escalations, assuming full responsibility for escalation management in their absence
• Independently manage assigned complex, high-visibility cases from intake through resolution, ensuring timely and satisfactory outcomes
• Handle escalated provider issues related to claims processing, roster management, credentialing, payment disputes, and network concerns
• Maintain detailed case documentation and provide regular status updates to the Senior Manager, executive leadership, and external stakeholders
• Act as a point of contact for providers during critical incidents, demonstrating empathy and professionalism
• Prepare executive briefings, response letters, and talking points for leadership regarding sensitive provider matters
• Coordinate with Claims, Provider Network, IT, Legal, and Compliance teams to investigate and resolve multi-faceted issues
• Conduct root cause analysis to identify systemic problems and prevent recurring escalations
• Generate reports on escalation metrics, resolution times, and recurring themes for senior management review
• Track and monitor key performance indicators related to provider satisfaction and issue resolution.

Senior Analyst, Provider Escalations – Associate Manager

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis support.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning.
• 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.

Utilization Management Clinical Consultant – Monday - Friday

Backend Engineer

• Be a technologist and work with other Engineers in planning, prioritizing and performing assigned tasks within deadlines.
• Lead, mentor and work with a team of engineers onsite and offshore to deliver multiple use cases and products.
• Collaborate with cross‑functional teams—including clinical product, interoperability, and EHR integration partners—to make design decisions, ensure performance optimization, and maintain code quality through testing, debugging, and reviews.
• Responsible for end‑to‑end application development & delivery, including production deployment, operationalization, and observability of services that support clinical workflows and integrations with major EHR systems (e.g., Epic, Athenahealth).
• Develop applications/web services and cloud native apps using Sprint boot , GCP, REST API and other tech stacks (Open source and proprietary).
• Unit testing using framework such as Junit, Mockito.
• Build and deploy services using GitHub, CircleCI, Harness as part of CI/CD process in leading Cloud Platforms – GCP (preferred) or Azure or AWS.
• Monitor App health and KPIs, support triage of any production issues as and when needed.
• Be an advocate for and implementer of security best practices.
• Adopt and apply industry technology best practices.
• Partner with Product owners, business partners and peer groups for long and short-range technical solutions that meet business requirements.
• Analyze and contribute to project and business requirements based on product team milestones and priority.
• Participate in Program Increment (PI) planning meeting and lead the work distribution amongst developers to meet delivery timelines.
• Actively participate in Agile Scrum team activities including Sprint Planning, Refinement, Iteration Reviews and Retrospectives.

Lead Java Software Engineer

Project Manager

• Optimizing operational efficiency and supporting strategic initiatives across the Call Center and Business Support teams.
• Analyzing queue performance and staffing metrics to ensure service level targets are met.
• Managing onboarding and administrative processes for contingent workers.
• Collaborating with internal stakeholders to drive priority projects to completion.
• Supporting financial operations through invoice tracking and coding validation, contributing to accurate and timely billing processes.