We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo
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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Join a high-performing actuarial team supporting CVS Health and Aetna's exciting and growing Medicaid business. Support CVS Health's financial integrity by leading actuarial forecasting with sound practices to meet the business needs and ensure reasonable actuarial projections. A Brief Overview The primary focus of this director role will be leading actuarial support for the financial forecast modeling of the Medicaid line of business with a secondary focus on trend analysis & development. This role will primarily provide oversight and leadership of activities related to forecasting with a secondary focus on trend normalization and projection. Fundamental Components Primary Role (70% time): Lead budget and forecast storytelling for the Medicaid business. Oversee forecast model development and improvement, and support plan actuaries in understanding forecast projections. Drive forecast related analysis including development of key assumptions, evaluation of financial experience and trend drivers. Review budget and forecast from a business perspective and ensure sound actuarial projections. Identify and support process improvement through automation and process simplification; assure timely and accurate deliverables. Manage high visibility and complex projects. Allocate and align resources. Se
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary We are seeking a Software Development Engineer In Test, to apply advanced software engineering skills to improve quality across the development lifecycle through scalable test frameworks, developer tooling, and reusable automation solutions. This is a senior individual contributor role for a developer who specializes in testing, testability, and quality engineering. This role combines hands-on engineering with technical leadership across teams. The individual will influence architecture, strengthen automation strategy, improve developer feedback loops, and help establish consistent quality engineering practices that scale across products and platforms. The role carries strong Software Development Engineer in Test expectations, with an emphasis on building engineering solutions that improve product quality, platform reliability, and development velocity. Primary Responsibilities Design, develop, and evolve scalable test frameworks, automation libraries, and developer-facing quality tools Understand how the broader software ecosystem works together and define quality engineering approaches that align to platform strategy Partner with Product, Architecture, and Engineering teams to define test strategy, coverage goals, and acceptance criteria Build reusable utilities, harnesses, mocks, stubs, and data solutions that improve system
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Workforce Optimization Manager plays a critical role in shaping and executing workforce strategies. This position leads the end-to-end lifecycle of workforce optimization initiatives. Acting as a trusted advisor, this role partners with leaders across all levels to align workforce plans with business objectives, proactively anticipate organizational needs, and mitigate risk through compliance with employment laws and sound governance. This role has no direct reports but manages an important process within the workforce optimization space. Key Responsibilities Drive end‑to‑end project management for high‑impact workforce optimization initiatives, operating effectively in grey areas where requirements, risks, and stakeholder inputs may be evolving. Partner closely with Government Affairs, Legal, Talent Acquisition, Communications, and HR to scope work, align resources, manage timelines, mitigate risk while managing the project plan. Serve as an enterprise‑wide strategic advisor to leaders at all levels, providing consultative guidance in complex, ambiguous, and high‑impact scenarios where solutions are not clearly defined and require strategic judgment, influence, and risk assessment to inform workforce strategy and future‑state design. Influence talent decisions by evaluating current capabilities against future organizational needs, iden
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Director of the Divestiture Management Office (DMO) will lead the team responsible for delivering on a Transition Services Agreements (TSAs) following the sale of a CVS Health business unit. This role serves as the primary liaison between CVS Health, the acquiring company, vendors, and impacted employees to ensure all transition commitments are successfully executed. The ideal candidate is a strong leader who can manage complex programs, build relationships across multiple stakeholders, and drive solutions in a fast-paced environment. Key Responsibilities Lead and manage the Divestiture Management Office and supporting team members. Oversee execution of Transition Services Agreement (TSA) commitments and contractual obligations. Build and maintain relationships with buyers, vendors, impacted employees, and CVS stakeholders. Review and interpret legal agreements, contracts, and transaction documents. Identify risks, issues, and improvement opportunities, and drive resolution through collaboration and negotiation. Provide clear updates, recommendations, and reporting to senior leadership. Manage project budgets and ensure financial goals are met. Track program performance through metrics, reporting, and governance processes. Lead project planning, execution, and continuous improvement efforts.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Software Engineer / Technical Lead (AI & Automation) will provide technical leadership for the design, development, modernization, and support of critical applications supporting Prior Authorization Operations (PAOps) under PBM line of business. This role will be responsible for building and maintaining scalable, cloud-native solutions that enable intelligent workflow automation, AI-driven decisioning, document processing, and business process optimization. The ideal candidate is a hands-on technical leader with strong software engineering and cloud architecture expertise, coupled with practical experience implementing Generative AI, Agentic AI, and Large Language Model (LLM) solutions in production environments. This individual will collaborate closely with Data Engineering, Data Science, Product, and Business teams to deliver highly available, secure, and scalable applications while driving innovation through AI-powered solutions. Key areas of focus include: Application architecture, development, and production support Cloud-native engineering and platform modernization Microservices and distributed systems AI/GenAI, Agentic AI, and LLM-based solutions Event-driven and streaming architectures Engineering best practices, mentoring, and technical leadership R
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Executive Director, Digital Engineering- Aetna Member Care and Journey Services is a senior technology leader responsible for setting the technical vision, architectural direction, and engineering execution for member centric services. This role leads large-scale engineering teams that build high-performance backend APIs, microservices, and cloud-native systems that power member experiences across digital, agent, provider, and partner channels. The leader ensures exceptional service stability, resiliency, innovation velocity, and alignment with enterprise user experience and operational goals. Key Responsibilities 1. Backend API & Microservices Engineering Leadership • Lead the design, development, and delivery of scalable backend systems, APIs, and microservices powering member-facing capabilities. • Define API contract standards, and integration patterns used across Member Services platforms. • Drive service modernization by adopting cloud‑native architectures, containerization, and event-driven patterns. 2. Service Stability, Observability & Resiliency • Establish standards for availability, resiliency, performance, and disaster recovery across all services. • Implement SLO/SLI/error budget frameworks, health checks, and high‑availability architectures. <p
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Dental Network Relations Senior Analyst, is the liaison between Aetna and an assigned group of DSOs. This role acts as a resource for all dental products (DHMO, PPO, Medicare) to DSO leadership and staff, providers, sales, and marketing to aid in the achievement of Aetna Key Performance Measures. This person serves as a subject matter expert, demonstrating a strong understanding of Aetna’s Dental Products and market position. The Senior Analyst negotiates provider contract language and compensation. This role is also responsible to work cross functionally to resolve provider concerns, document resolution, and effectively communicate to all parties. Responsible for account management of DSOs and large dental groups to support network strategic initiatives. Negotiates contracts at all organizational levels. Strong emphasis on analysis to develop cost-of-care strategy. Solid focus on data analytics to identify cost savings opportunities Collaborates cross-functionally to resolve provider issues with the utmost urgency. Recruits providers as needed to attain network expansion and meet access needs. Communicates early warning signs of potential issues/risks to management. Required Qualifications: 2+ years of experience in provider relations, network management, healthcare contracting, dental insurance, o
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Serves as the central execution and coordination lead for complex, cross-functional initiatives within the Medicare Part D product and strategy organization. Establishes clear visibility into what initiatives exist, who owns them, how they are progressing, and what dependencies must be managed to deliver results on time. Translates strategic priorities into structured plans, timelines, progress tracking, and executive-ready summaries that help leadership assess status, risks, and next steps. Required Qualifications 7–10 years of relevant experience, including project, program, or initiative management in healthcare, insurance, or a related field. Strong working knowledge of Medicare Part D, including regulatory, operational, and product considerations. Demonstrated ability to manage multiple complex initiatives simultaneously and translate strategic priorities into operational plans with measurable outcomes. Exceptional organizational skills with strong attention to detail and the ability to manage dependencies, sequencing, and critical paths. Proven experience creating clear summaries, dashboards, timelines, roadmaps, and visuals for senior leadership. Strong written and verbal communication skills, including the ability to frame communications for executive and cross-functional audiences. Experience supporting Medica
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Dental Network Relations Senior Analyst, is the liaison between Aetna and an assigned group of DSOs. This role acts as a resource for all dental products (DHMO, PPO, Medicare) to DSO leadership and staff, providers, sales, and marketing to aid in the achievement of Aetna Key Performance Measures. This person serves as a subject matter expert, demonstrating a strong understanding of Aetna’s Dental Products and market position. The Senior Analyst negotiates provider contract language and compensation. This role is also responsible to work cross functionally to resolve provider concerns, document resolution, and effectively communicate to all parties. Responsible for account management of DSOs and large dental groups to support network strategic initiatives. Negotiates contracts at all organizational levels. Strong emphasis on analysis to develop cost-of-care strategy. Solid focus on data analytics to identify cost savings opportunities Collaborates cross-functionally to resolve provider issues with the utmost urgency. Recruits providers as needed to attain network expansion and meet access needs. Communicates early warning signs of potential issues/risks to management. Required Qualifications: 2+ years of experience in provider relations, network management, healthcare contracting, dental insurance, o
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Profile Summary Leads automation and AI transformation strategy across the Payment Integrity, Revenue Integrity, and Grievances and Appeals COEs. Builds and manages a team to ideate, prioritize, and oversee delivery of automation and agentic AI initiatives that improve claims accuracy, recovery, and appeals outcomes. Partners with COE and business leadership to align automation roadmaps to enterprise priorities, governance standards, and measurable business impact. Job Description A Brief Overview Leads a team to drive automation and AI-enabled transformation across Payment Integrity, Revenue Integrity, and Grievances and Appeals. Sets strategic direction for how automation and intelligent workflow opportunities are identified and scaled across these COEs, and ensures successful, on-time delivery through strong program oversight. Balances delivery accountability with team development, ensuring the group operates as a cohesive practice rather than three disconnected initiatives. What you will do Leads and develops a team, setting priorities, allocating capacity across COEs, and holding the team accountable to delivery and quality standards. Sets the automation transformation strategy for Payment Integrity, Revenue Integrity, and Grievances and Appeals in partnership with COE leadership. <
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Dental Network Relations Senior Analyst, is the liaison between Aetna and an assigned group of DSOs. This role acts as a resource for all dental products (DHMO, PPO, Medicare) to DSO leadership and staff, providers, sales, and marketing to aid in the achievement of Aetna Key Performance Measures. This person serves as a subject matter expert, demonstrating a strong understanding of Aetna’s Dental Products and market position. The Senior Analyst negotiates provider contract language and compensation. This role is also responsible to work cross functionally to resolve provider concerns, document resolution, and effectively communicate to all parties. Responsible for account management of DSOs and large dental groups to support network strategic initiatives. Negotiates contracts at all organizational levels. Strong emphasis on analysis to develop cost-of-care strategy. Solid focus on data analytics to identify cost savings opportunities Collaborates cross-functionally to resolve provider issues with the utmost urgency. Recruits providers as needed to attain network expansion and meet access needs. Communicates early warning signs of potential issues/risks to management. Required Qualifications: 2+ years of experience in provider relations, network management, healthcare contracting, dental insura
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Project Manager, Events coordinates the end-to-end execution of external events that showcase Aetna’s industry expertise, highlight differentiated solutions, and strengthen partnerships with external partners to drive sales growth and retention. They manage multiple concurrent projects, ensuring alignment with business objectives while increasing awareness of available tools and resources across both internal and external stakeholders. The role partners closely with sales leaders, strategic partnerships, subject matter experts and marketing to deliver high-impact experiences. Required Qualifications 5-7 years exceptional organizational and prioritization skills, with the ability to manage multiple projects simultaneously Strong verbal and written communication skills, with the ability to engage stakeholders at all levels Proven ability to collaborate across cross-functional teams Demonstrated project management expertise with a track record of delivering on timelines and milestones Ability to proactively identify challenges and drive solutions to maintain momentum Ability to operate effectively in a fast-paced, matrixed environment Preferred Qualifications PMP certification Education Bachelor's degree or equivalent experience
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary In this role as Manager – FP&A business, you will report to the Lead Director of Service Ops FP&A. You will be responsible for consolidating, reporting and the creation of management presentations and or talking points for forecasts, budget and the strategic plan for the Operations Enablement & Provider Services (OEPS) org within Service Ops. This role will work closely with various leaders within the Business, as well as Finance, ensuring accurate reporting of forecasts, budgets, and strategic plans and providing senior leadership with the appropriate level of detail. The successful candidate should demonstrate strong communication skills, the skill to develop a deep understanding of expense allocations, and the ability to consolidate and report results to business partners and management. You must be able to multi-task and prioritize in a fast-paced environment, work independently with guidance from management, and deliver financial reporting and analysis on both regular and ad hoc frequencies, including creating financial models and supporting exhibits in PowerPoint. We are looking for individuals with a solid understanding of budgeting, forecasting, and analytical financial reporting. Required Qualifications Minimum of 5 years of experience Ability to develop reporting and consolidate results to business p
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Seeking a Senior Analyst to join the Group Medicare Advantage Actuarial team to assist with Part C analysis & pricing. More specifically, this role will be responsible for the following: Updating assumptions used in pricing Part C Maintaining existing portfolio view reporting Supporting plan sponsor experience refund reconciliations and UW data/reporting needs Collaborating with Underwriting on plan sponsor pricing opportunities for both new business and renewal business Required Qualifications Bachelor’s degree along with 3+ years related experience Prior healthcare experience Experience working with large and detailed data sets Preferred Qualifications Strong communication and collaboration skills Solid technical, analytical, and creative problem-solving skills Be organized, data driven, statistically minded and demonstrate an attention to detail Be self-motivated, intellectually curious with a desire to continuously improve processes Be adaptable as business needs and priorities evolve Familiarity with Medicare Part C and/or Group pricing Education Bachelor’s degree or higher in act
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