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
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Lead Director in Ct Hartford
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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. 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. 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 Lead Director, Stop Loss Relationship Management will serve as the single accountable owner for enterprise stop loss relationship strategy, governance, escalation management, and operational performance. This role is responsible for creating a more disciplined, scalable, and consistent operating model across stop loss carriers, internal business partners, and cross-functional stakeholders. This leader will address current gaps in ownership, decision rights, escalation pathways, and carrier performance that are contributing to delays, disputes, reimbursement challenges, and financial exposure. The role will centralize accountability for stop loss-related funding decisions, risk acceptance, issue resolution, and carrier engagement, ensuring clearer governance, faster resolution of high-cost claim issues, and improved predictability across the stop loss ecosystem. The ideal candidate is a strong enterprise relationship leader with deep experience managing complex, cross-functional programs, executive-level stakeholders, financial risk, operational escalations, and external partner performance. This individual must be highly effective at driving alignment, establishing governance, improving processes, and influencing outcomes across matrixed teams. What You Will Do Serve
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 The Waste & Error Certified Coding Manager is responsible for leading the Certified Coding Analyst and W&E Team Lead roles that conduct medical claim reviews and coding audits to identify billing errors, waste, abuse, fraud, and payment integrity opportunities. The Manager provides direct people leadership, establishes operational priorities, ensures consistent application of coding and billing requirements, and is accountable for team productivity, quality, service levels, compliance, and employee development. This role partners closely with the W&E team lead, who provides day-to-day technical guidance and subject matter support to the coding team. The Manager retains accountability for staffing, performance management, workload oversight, escalations, audit readiness, process improvement, and delivery of business outcomes. The position also represents the team in discussions with senior leadership, Medical Directors, Legal, Compliance, Analytics, Operations, and other Payment Integrity partners. Primary Responsibilities People Leadership & Team Development Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts. Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures. Conduct regular perfor
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 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. Help Transform the Future of Accounting Are you passionate about improving accounting processes, driving automation, and leading high-performing teams? Join our Accounting Center of Excellence and play a key role in modernizing accounting operations, strengthening financial controls, and supporting business growth. In this role, you'll lead accounting teams, improve processes, implement technology solutions, and partner across Finance to ensure accurate, efficient, and scalable financial operations. What You'll Do Lead accounting operations across areas such as payroll, service operations, clinical accounting, and the financial close process. Manage and develop accounting professionals, including offshore team members. Improve efficiency through process standardization, automation, and continuous improvement initiatives. Oversee month-end, quarter-end, and year-end close activities, ensuring accuracy and compliance. Partner with Finance and business leaders to solve accounting issues and enhance processes. Lead transformation projects, including workflow automation and SAP S/4HANA initiatives. Use data and analytics to improve reporting, controls, and decision-making. Coach and mentor team members to build a strong, high-performing organization. Identify opportunities to simplify processes and implement scalable s
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