Senior Quality Improvement Professional in United States

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 Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven

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 CVS Health is seeking a Senior Varicent Integration & Platform Engineer with expertise in technical architecture and integration to join the Human Resources Technology team. This experienced and motivated professional will support Compensation business operations by delivering optimal, scalable technology solutions. As an integral member of the team responsible for the Varicent Sales Performance Management (SPM) platform, its integrations, and its technical architecture, this role will address the needs of Total Rewards and Human Resources business partners and stakeholders. The ideal candidate will combine deep technical and platform expertise with a demonstrated ability to collaborate with technical and non-technical partners. The role will provide essential support to the Compensation organization for sales incentive technology needs and will collaborate with HR Technology, Centers of Excellence (COEs), and HR Shared Services across all business segments. This individual will establish cross-functional relationships throughout HR Technology and Human Resources to ensure that solutions and initiatives are effectively designed and implemented, with colleague satisfaction as a key goal. Primary Responsibilities: Collaborate with business and technical partners to support the Varicent technical architecture and integration roadmap, including the e

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: Builds strategic partnerships with assigned producers and customers to achieve profitable growth and cross sell objectives for assigned business or customer segments, products, and assigned geographies. Strong understanding of customer needs and expectations across multiple market segments. Moderate influence on the sale and retention of business. Fundamental Components: Oversees targeted business prospects to develop new opportunities and cross sell business to ensure profitable customers and help grow the business through consultative consulting, issue resolution, and superior service. Manages and builds producer relations as needed depending on book of business or market segment(s) being supported. Identifies opportunities to partner with the client by drawing from the entire spectrum of product lines, illustrating a keen understanding of clients' multifaceted needs and benefits utilizing Aetna's full product array (e.g., fully vs. self-insured, product combinations and/or product specializations by industry). Develops, executes, and communicates company objectives that are aligned with prospect’s objectives, financial position, and employee benefits strategy. Coordinates sales materials, testimonials, and support from SME’s to put together presentations for clients. Delivers organized polished presentatio

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. As a Senior Workday Integration Developer – Workday Studio you will be responsible for designing, developing, implementing, and maintaining integrations between Workday and other internal or external systems. This role requires deep technical expertise in Workday’s integration tools, integration methodologies and best practices to ensure data flows smoothly and accurately between Workday and other enterprise and external systems. Responsibilities include: Designing Integration Solutions: Leading the design and development of integration solutions between Workday and external systems (such as payroll, benefits, HR, finance, or third-party applications). Writing code, developing software components, and implementing complex functionalities according to project requirements. Workday Studio: Using Workday Studio to develop complex integrations involving multiple systems, including configuring web services (REST/SOAP), developing transformation logic, and handling data mappings. Pre-built Connectors: Leveraging Workday Cloud Connect and other pre-built connectors to integrate Workday with third-party applications efficiently. Customization: Customizing integrations to meet the unique business requirements of the organization, ensuring they align with Workday’s best practices. Develop Integration Workflows: Building int

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. Senior Medical Director, Clinical Informatics Position Summary The Senior Medical Director for Clinical Informatics and Healthcare Delivery (HCD) Technology Product serves as the senior physician leader across healthcare delivery technical domains, providing clinical insight and technical expertise to drive end-to-end technology execution and ensure that Epic-enabled solutions advance core business outcomes. This role is the clinical expert and trusted physician advisor for teams across HCD technology, driving effective enterprise governance, improving clinician experience, enhancing patient outcomes, and supporting organizational strategic priorities. The Senior Medical Director will also serve as the product leader for two core HCD technology domains - Center Operations and Quality/Stars. The Senior Medical Director brings hands-on clinical and Epic build expertise, partners closely with operational and technical leadership across the enterprise to align the Epic roadmap with organizational strategy, has excellent clinical judgement and keeps patient experience, safety, and outcomes at the center of everything we do, and represents the clinical voice in enterprise governance, escalation, and innovation efforts. Key Responsibilities Clinical Product & Technology Leadership Serve as the senior product leader across Clinic Operations and Quality

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 CVS Health is looking for a Functional & Technical Expert for the Varicent Sales Performance Management (SPM) platform to join our Human Resources Technology team. We’re seeking an experienced and motivated individual who is ready to take on the challenge of supporting Compensation business operations by providing optimal and scalable technology solutions. This person will be an integral part of a team responsible for Compensation solutions meeting the needs of CVS Health’s Total Rewards, and Human Resources business partners and stakeholders. The ideal candidate will possess a combination of functional and technical expertise, as well as a demonstrated ability to work collaboratively with both technical and non-technical partners. You will provide integral support to the Compensation Team for their sales incentive technology needs collaborating with HR Shared Services across all business segments. You will establish cross-functional relationships throughout HR Technology and Human Resources to ensure solutions and initiatives are effectively designed and implemented. Primary Responsibilities : Collaborate with business and technical partners to support the Compensation functional area for Sales Incentives, including the established list of global priorities and roadmaps. Work closely with business leaders and stakeholders to develop v

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. A Brief Overview Designs enterprise-wide and/or cross-functional solutions to address business problems. This work results in initiatives that significantly impact organizational strategy, enabling the organization to be competitive in the marketplace and effectively serve its customers. Partners with business owners to optimize the achievement of strategic business objectives, to include profitable growth and improved organizational effectiveness. What you will do Directs the day-to-day complex business consulting operations to support the organization's goals and objectives. Administers processes and assignments for research, collecting, analyzing, and compiling data and information for the business consulting department reports. Handles files, reports, and financial records, and manages department record retention. Leads individuals to develop a high degree of customer service by fielding internal and external inquiries, finding resolutions, or redirecting as appropriate. Collaborates internally and externally with clients and senior management regarding the organization's goals and objectives. Advises the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management. Develops reports for the org

Senior DevSecOps Software Engineer Company: The Boeing Company The Boeing Company has an exciting opportunity for a Senior DevSecOps Software Engineer to support the Protected Tactical Enterprise Service (PTES) team in Colorado Springs, CO. As a DevSecOps Engineer on the Protected Tactical Enterprise Service (PTES) team, you will be responsible for integrating security practices within the development and operations lifecycle of tactical enterprise systems. You will collaborate closely with software developers, security teams, and infrastructure engineers to design, implement, and maintain secure, automated CI/CD pipelines, ensuring the delivery of resilient and compliant services in protected operational environments. Position Responsibilities: Leads the design, development, analyses, and maintenance of software systems that meet industry, customer and internal quality, safety, security and certification standards Partners with appropriate stakeholders to inform system definition and reviews translation of system-level requirements into software requirements and models that meet customer, operational and performance requirements and have clear traceability to design, code and test artifacts Reviews completion of software system-level analyses to identify risk, issues and opportunities; leads integration and deployment of mitigation actions throughout the software lifecycle. Leads code reviews to ensure alignment to requirements and standard Leads monitoring and reviewing test completion, verification processes and issue resolution for software systems Leads development of user documentation and training to educate end users about usage of software products Leads review of pr

Become a part of our caring community As a Senior Product Manager, you will help guide in-flight products that improve the customer journey and create meaningful healthcare experiences. In this role, you will partner closely with business, technology, and design stakeholders to align priorities, solve complex problems, and help teams deliver high-quality outcomes. We are looking for an experienced, collaborative, and customer-focused Senior Product Manager who is excited to work across business and technology teams to build solutions that make healthcare experiences simpler, more useful, and more human. In this role, you will bring a product mindset, strong communication skills, and the ability to turn complex needs into clear, practical solutions. You will collaborate with technical and non-technical partners, use data and customer insights to guide decisions, and help teams stay focused on delivering value. The right candidate brings significant stakeholder management experience and is comfortable navigating ambiguity, building trust across organizations, and leading with curiosity, sound judgment, and empathy. The role also requires the ability to break down complex business and technical problems into a clear product roadmap, epics, and user stories. You will be expected to write complete user stories with acceptance criteria, support story acceptance, and take responsibility for acceptance testing to ensure delivered capabilities meet business and user needs. Required Qualifications 2–4+ years of relevant product management experience, including examples of products or capabilities you helped bring to market. Experience delivering business value through lean product management, customer discovery, or human-centered design practices. Significant experience managing stakeholders across multiple business and technology orga

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 us at the start of a new era in health care where technology is transforming how and where care is delivered, creating a more connected, effective care experience for all. Our mission at Signify Health is to build trusted relationships to make people healthier. We do this by transforming the home into a health hub through a combination of data, technology & people. We are building a unified technology platform for value-based care that is improving care and reducing spending by treating patients in lower-cost settings and linking providers’ payments to patient outcomes. Signify Health is driving this industry transformation and solving some of the most challenging problems in healthcare – this is where you come in! About the Role As a Senior Software Engineer, you’ll be a key member of a collaborative team responsible for design, delivery and operation of business-critical, distributed systems. We’re looking for technically strong, passionate people with an entrepreneurial spirit to build and sustain innovative solutions. Basic Qualifications 5 years of software development experience. Strong foundation in software engineering: problem solving, data structures, algorithms, patterns, concurrency. Strong understanding and demo

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. Company: Oak Street Health Title: Senior Manager - Strategic Business Analytics Location: Remote/Virtual Role Description: The Sr. Manager, Strategic Business Analytics is responsible for owning and advancing Oak Street Health’s enterprise performance reporting ecosystem, ensuring leaders across the organization have timely, accurate, and actionable insights to drive decision-making. This role serves as the operational leader for delivery of Blueprint, the OKR dashboard, and Center Performance reporting, while building scalable reporting processes and automation capabilities that reduce manual effort and improve consistency. The role acts as the primary point of contact for strategic analytics requests, balancing ongoing reporting commitments with emerging business priorities. In partnership with Business Intelligence, Governance, Operations, and cross-functional stakeholders, the Sr. Manager ensures reporting solutions remain aligned with governed metric definitions and organizational objectives. This leader will oversee a team of analysts, manage reporting infrastructure and bridge solutions, and drive the transition from manual reporting processes to scalable, automated delivery models that support Oak Street Health's continued growth. Core Responsibilities: Own the delivery, accuracy, and timeliness of Blueprint

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 At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a Senior Manager Medicare Product, Vendor Management Contract Lead you will play a critical role contracting, negotiations, oversight of vendors and assisting in achieving CVS goals, work strategically together, and remain as adaptable as possible in an ever-changing environment. This role's scope of responsibility includes overseeing the following in relation to Medicare Product vendor management: Finance, Contracts, Invoicing, Negotiations, Provisioning, Aetna Medicare Supplemental & Duals benefits, Vendor relationship management, Compliance oversight, Auditing, and projects as assigned. The Senior Manager, Vendor Management Contract Lead is a high impact role. You will lead advance contract and negotiation skills, work with other partner to identify root cause, address, and resolve vendor issues, manage vendors to the contract SLAs, performance guarantees and provide insight into complex vendor problems. Responsibilities include: Work assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-dep

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, Market Intelligence will lead strategic workstreams end-to-end, directing team analysis and shaping executive-ready recommendations on the enterprise's most important growth and corporate development questions. Partnering closely with the Enterprise Strategy team, this role drives market research, competitive analysis, and project management to identify growth opportunities, assess markets, and support M&A and partnership evaluation. The Senior Manager will leverage AI-enabled research and market intelligence tools to accelerate insight generation and inform enterprise decision-making, while coaching junior colleagues and building alignment across senior stakeholders. Key Responsibilities Lead one or more Market Intelligence workstreams by defining scope, structuring plans, and adjusting course as priorities evolve. Analyze market trends, competitive dynamics, macroeconomic factors, and growth opportunities to shape strategic recommendations. Direct hypothesis-driven analysis, ensuring insights are accurate, timely, and decision-ready. Synthesize qualitative and quantitative insights into clear points of view by challenging assumptions, reconciling differing perspectives, and connecting findings to broader strategic implications. Craft executive-ready narratives, business cases, and recommendations