Jobs at CVS Health

Lead strategy and delivery for an AI-powered claims decision-support and auto-adjudication platform. Define vision and roadmap, manage a team of product managers, partner with business, engineering, and data science, and drive adoption, impact measurement, and executive-level communication across a complex, matrixed enterprise.

Lead development and delivery of enterprise risk adjustment analytics and BI solutions. Translate clinical, claims, and operational data into actionable provider and market-level insights, drive KPI reporting, modernize analytics via AI/automation, oversee BI platform strategy, and lead a team to support stakeholders across Risk Adjustment, Finance, Clinical, and IT.

Develop and maintain labor standards via time studies (MOST/MTM) and work sampling, document SOPs, lead Lean Six Sigma continuous improvement projects, analyze and visualize data (SQL/BI, Excel, Minitab), and perform on-site observations to improve productivity, quality, and customer experience.

Maintain accurate setup and maintenance of Employee Assistance Program plans in a custom EAP platform. Perform high-volume data entry, validate benefit and pricing data, support implementations, produce operational reports, collaborate with Sales and Account Management, identify process gaps, and recommend workflow improvements to enhance accuracy and customer experience.

Lead development and execution of specialty pharmacy clinical programs and patient journeys. Serve as enterprise clinical SME for assigned therapy portfolio, partner with manufacturers and internal stakeholders to secure access, launch drugs, design omnichannel care solutions, and deliver clinical education. Analyze market trends, manage product lifecycle, present to clients, and optimize patient and prescriber solutions to improve outcomes and enterprise value.

Design, integrate, and implement on‑prem and cloud data warehousing solutions. Process payer files into the data warehouse, write SQL/Python/PySpark code, perform dimensional modeling, troubleshoot data issues, improve performance, and collaborate with engineers, analysts, data scientists, and product teams.

Provide employee relations advice and case management for business units: conduct investigations, ensure policy and legal compliance, coach leaders, manage escalations, recommend corrective actions, deliver training, connect employees to resources, document cases, and meet case management metrics while handling confidential information.

Provide compassionate leave-of-absence support via the myLeave call center, handle inbound colleague inquiries, document/escalate complex cases, meet call center metrics, promote self-service tools, and assist with continuous process improvements and case management tasks.

Build and maintain a full‑stack self‑service data platform using React (TypeScript) and Python. Implement frontend components, backend APIs, Kafka integration, data preview, logging/observability, automated tests, and CI/CD. Collaborate with senior engineers, participate in code reviews, and leverage AI development tools to improve development and deployment workflows.

Lead end-to-end Salesforce initiatives: define scope, timelines, budgets and resources; manage risks and stakeholders; coordinate analysts, developers, architects and QA; ensure data governance, security and change management compliance; provide executive updates and identify opportunities for process and Salesforce optimization to deliver projects on time and on budget.

Lead end-to-end onboarding and implementation of complex, customized pharmacy and health plan solutions. Serve as client-facing consultant on product selection and plan design, manage multiple concurrent implementations, coordinate internal and external stakeholders, ensure timelines and quality, escalate risks, and drive retention and account growth.

Own roadmap and end-to-end delivery of analytics products for sales and underwriting. Write clear technical requirements, set and track KPIs, prioritize requests, ship incrementally, measure outcomes, and iterate. Bridge data science, engineering, and business stakeholders to drive adoption and business impact.

Manage promotional strategy and communications for a national plan sponsor: develop annual plans, create targeted content and toolkits, coordinate vendors and resource groups, produce multi-channel materials, support urgent/crisis communications, report utilization, and present to clients and internal teams.

Perform utilization management reviews: assess clinical information, apply criteria/policies, render coverage determinations, coordinate with providers, identify referral opportunities, and promote appropriate benefit utilization. Work involves computer-based documentation, multi-system navigation, and frequent phone communication in a productivity-driven office setting.

Activate and operationalize clinical data for analytics by designing data models, taxonomies, and a clinical feature store; build reusable data assets, documentation, and dashboards; ensure data quality and compliance; partner with stakeholders and data engineering to enable downstream analysts, data scientists, and business users.

Lead design and delivery of cloud-native solutions aligned to product outcomes. Translate requirements into secure, scalable cloud architectures (GCP preferred), build data/AI/ML platforms, implement data pipelines, APIs and ML workflows, enforce cloud best practices (security, performance, cost), and drive MLOps/DevOps, IaC, and production readiness across product and engineering teams.

Serve as the centralized escalation and Level 2 support lead for employer billing operations, oversee migration from legacy billing tools to the Aetna Employer Portal, lead training and UAT, drive process improvements, and collaborate with cross-functional teams to ensure seamless billing operations and change management.

Serve as a quality champion for claims processing and customer service by performing regular audits, measuring compliance, reporting results, and recommending training and controls. Consult cross-functionally, support targeted quality audit projects, and act as subject-matter expert on quality workflows, systems, and policies to improve customer satisfaction and operational efficiency.

Serve as centralized point of contact for enrollment issues in the Aetna Employer Portal. Provide L2 support, lead UAT, manage user provisioning and legacy migrations, drive process improvements, deliver training/communications, monitor enrollment metrics, and coordinate cross-functional readiness for portal launches.

Own and drive the backend platform and API product roadmap, define API design/versioning/governance, lead third-party and EHR integrations (FHIR/SMART), partner with engineering on event-driven microservices, build ROI-based cases, and act as product owner for backend squads to track API adoption and platform KPIs.