Jobs at CVS Health

Owns the lifecycle of AI-powered analytics products supporting clinicians, from requirements and discovery through production and maintenance. Partners with data scientists, engineers, clinicians, and executives to define roadmaps, prioritize trade-offs, establish data contracts and SLAs, validate model results, track performance, and demonstrate ROI. Leads Agile scrum teams and drives cross-functional delivery in complex healthcare environments.

Processes and adjudicates healthcare benefit claims, verifies eligibility and coverage, applies medical coding and medical necessity guidelines, investigates discrepancies, manages claim queues, and communicates with providers and members. Documents claim data accurately, ensures regulatory and policy compliance, processes rework claims, and analyzes trends to support operational improvements. The role includes 12–20 weeks of virtual training and requires strong communication, organization, customer service, and multitasking skills.

Supports and enhances Workday Core HCM for domestic and international employees. Gathers requirements, performs fit-gap analysis, designs and configures solutions, manages testing and documentation, supports semiannual releases, resolves defects, and partners with HR, Payroll, technical teams, and vendors. Develops reports and analytics, maintains the product roadmap, communicates impacts, and helps optimize HR and Payroll processes.

Supports account managers serving health benefits customers by coordinating eligibility, enrollment, documentation, renewals, billing inquiries, issue resolution, and customer communications. Analyzes account data and service trends, maintains Salesforce records, tracks implementation and renewal activities, and collaborates with customers, brokers, and internal teams to improve satisfaction and retention.

Directs implementation of self-funded customer benefit plans for new business clients. Acts as the primary contact, coordinates internal and external stakeholders, manages deliverables, resolves issues, executes implementation strategies, evaluates exceptions, and supports continuous process improvement while meeting customer expectations and performance guarantees.

Design, develop, test, debug, and architect scalable native iOS solutions. Participate in technical design, code reviews, performance optimization, mobile best-practice adoption, and cross-functional decision-making. Collaborate on complex features, share knowledge through talks and workshops, and mentor junior developers. Contribute to enterprise mobile solution strategy and the technical direction of digital engineering projects.

Provides compassionate support to members seeking emotional, behavioral health, and employee assistance resources through phone, video, and chat. Assesses needs, provides referrals and benefit education, recognizes warning signs, de-escalates challenging situations, facilitates clinical transfers, documents interactions, and maintains confidentiality while navigating multiple systems in a fast-paced service environment.

Designs and leads Epic-based solutions supporting Medicare Star Ratings, HEDIS, and NCQA quality measures. Translates quality specifications into Epic build requirements, develops registries, care gap alerts, reporting frameworks, and dashboards, and ensures accurate data capture and interoperability through FHIR and HL7. Partners with clinical quality, population health, analytics, and leadership teams; oversees testing, governance, documentation, compliance, release management, and continuous optimization. Mentors junior staff and guides the technical roadmap for Epic STARS capabilities.

Directs benefit plan implementation for self-funded new business clients. Coordinates internal and external stakeholders, manages project deliverables, resolves implementation issues, develops execution strategies, evaluates client-requested exceptions, and drives continuous process improvement while meeting customer expectations and performance guarantees.

Performs pharmaceutical rebate reconciliation, payment tracking, dispute resolution, reserve analysis, variance investigation, and financial reporting. Reviews contract terms, analyzes manufacturer payment data, identifies late or disputed payments, communicates with pharmaceutical manufacturers and internal partners, maintains dispute records, and responds to balance inquiries. Requires strong analytical, organizational, communication, and problem-solving skills, plus experience with Excel and financial or analytical work.

Negotiate and manage provider contracts, single-case agreements, disputes, and settlements for Aetna. Analyze forecast and cost changes, develop impact assessments and process improvements, and support cost-saving initiatives. Maintain relationships with providers and internal teams, ensure contract performance meets compliance, quality, accessibility, and financial goals, and coach junior colleagues. The role requires expertise in provider contracting, claims operations, patient management, and Aetna systems.

Conducts complex investigations of dental providers and practices involving healthcare fraud, waste, and abuse. Prepares evidence and case referrals for clinical, legal, leadership, and law-enforcement review; documents case activity; supports corrective actions and fraud-prevention controls; presents findings; and provides testimony in civil and criminal proceedings. Requires healthcare fraud investigation experience, research and data-analysis skills, medical terminology knowledge, and business travel for legal proceedings.

Leads implementation of customer benefit plans for self-funded healthcare clients. Manages project planning, timelines, budgets, deliverables, risks, quality controls, change management, stakeholder communication, and post-project improvement initiatives. Coordinates cross-functional teams, resolves issues, prepares progress reports, manages multiple projects, and coaches junior colleagues. Requires significant healthcare client-facing and project management experience.

Lead the architecture, development, and operation of enterprise-grade full-stack software for clinician-facing and performance-management experiences. Design distributed systems, drive technical initiatives, improve scalability and maintainability, adopt modern technologies, deliver iterative releases, and collaborate across organizations. Mentor engineers and establish strong engineering practices. The role requires polyglot programming, cloud platforms, modern front-end development, SQL, distributed systems, and production operations experience.

Lead and contribute to the design, development, and delivery of scalable enterprise software platforms. Responsibilities include creating proofs of concept, designing microservices and APIs, optimizing performance, participating in architecture discussions and code reviews, supporting CI/CD automation, resolving complex issues, mentoring developers, and collaborating with business and technology leaders. The role also applies cloud, Generative AI, and Agentic AI capabilities to digital healthcare products.

Designs, develops, deploys, and supports complex integrations between Workday and internal or external systems. Builds Workday Extend and Orchestrate applications, configures Studio integrations and connectors, manages APIs, data migration, release updates, documentation, production support, and incident resolution. Partners with technical and business stakeholders, coordinates vendors, contributes to Agile projects, and mentors team members while ensuring scalable, secure, and maintainable integration solutions.

Lead AI adoption and enablement for Pharmacy Services Finance by delivering role-based training, workshops, coaching, communications, prompt libraries, and practitioner communities. Measure adoption and learning effectiveness, identify literacy gaps, support responsible AI use, and convert coaching insights into reusable resources. The role focuses on Microsoft Copilot and Claude tools, stakeholder collaboration, behavior change, and hands-on support rather than AI engineering, governance ownership, or product management.

Reviews and adjudicates routine medical claims, verifies eligibility and benefit coverage, applies coding and medical necessity guidelines, identifies discrepancies, and ensures accurate processing within turnaround requirements. Communicates with providers and members, investigates claims requiring additional review, handles correspondence, routes complex claims, and analyzes claims data for trends and process improvements.

Leads the strategic roadmap and value realization for CVS Health’s Clinical Insights Engine across screening, diagnosis, quality measurement, and care management. Partners with platform product managers, clinical leaders, business owners, and technology teams to integrate business priorities with platform capabilities. Oversees adoption, KPI monitoring, business-case development, stakeholder alignment, and continuous product improvement while ensuring measurable clinical and financial outcomes.

Supports cross-business strategy and operations for CVS Health’s Diversified Commercial Solutions organization. Responsibilities include managing financial and business-priority reporting cadences, leading cross-functional strategic initiatives, improving collaboration across a complex matrixed organization, and developing content for executive meetings and external events. The role partners with senior leadership to drive execution, transparency, growth, and operational accountability.