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 highly skilled Senior Data Engineer, Observability Engineering to join the Enterprise Observability Platform organization and help advance the next generation of observability, infrastructure, and security data capabilities. The Senior Data Engineer, Observability Engineering will play a critical role in designing, building, and operating scalable data pipelines and data products that power enterprise observability, operational intelligence, and security analytics across the organization. The Senior Data Engineer, Observability Engineering is a senior individual contributor responsible for developing and optimizing Databricks-based data engineering solutions that ingest, transform, govern, and deliver high-volume telemetry, infrastructure, application, and security data. This role combines deep hands-on technical execution with ownership of engineering excellence, operational reliability, performance optimization, and data platform best practices. Working closely with Observability Engineering, Security Engineering, Infrastructure Engineering, and Data Platform teams, the Senior Data Engineer, Observability Engineering will contribute to the evolution of the enterprise observability lakehouse by building resilient ingestion frameworks, establishing data quality standards, enhancing governance controls, and driving efficient, scalable data processing patter
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We Are Hiring Experienced Chef Nagpur in United States
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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. A Brief Overview Remove impediments, foster cross-functional collaboration, support Product Owners, and meet with business leaders to support one or more major project initiatives for Medicare. This role differs from a traditional Scrum Master by having a broader focus on overall delivery flow and, often, a more direct hand in stakeholder management and project governance. Key Responsibilities Agile Coaching & Facilitation: Fostering a culture of continuous improvement, mentoring teams on Agile values, and facilitating ceremonies (stand-ups, planning, retrospectives). Delivery Management: Managing project scope, timelines, and dependencies while tracking progress through metrics like velocity and quality. Impediment Removal: Proactively identifying and clearing roadblocks that prevent the team from achieving goals. Stakeholder Alignment: Serving as a liaison between stakeholders and the team, managing expectations, and ensuring transparent communication. Process Improvement: Refining Agile practices to increase efficiency, quality, and effectiveness. Required Qualifications 7-10+ years of experience in Agile delivery, Scrum Master, Agile Coach, Program Delivery, or related roles. Familiarity with software development, DevOps, or technical
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 Technician I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Tech I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Tech I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills. This position requires schedule flexibility including rotations through nights, weekend and holiday coverage. Required Qualifications - 1 year experience in customer service or call center environment - Must be able to work from home - Have high speed internet Preferred Qualifications - Previous experience in pharmacy or healthcare industry. - Associate's or Bachelor's Degree. Pharmacy Technician License Education High School Diploma or equivalent GED Anticipated Weekly Hours 40<p style="text
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. If you're looking to make a global difference in your next role, this opportunity is for you. Aetna International is seeking an Analyst, Account Manager who is passionate about delivering an exceptional customer experience and supporting the ongoing success of our Access U.S. customers. In this role, you will partner with Account Managers, customers, brokers, and internal business partners to provide day-to-day operational and service support throughout the customer lifecycle. You will help drive customer satisfaction and membership retention through proactive coordination, accurate execution, consultative problem-solving, and timely issue resolution. The Access U.S. business provides comprehensive health benefit solutions for U.S.-based employees of multinational organizations. Through a range of medical plans, wellness programs, digital health tools, global support services, and dedicated account management, Access U.S. helps employers offer competitive benefits while providing members with access to high-quality care and a personalized health care experience. Position Summar y Supports the Account Management team in delivering a consistent, high-quality experience for Access U.S. customers, brokers, and members. Provides operational and administrative support across eligibility, enrollment, benefit documentation, customer service activities, and issue resolution. Collaborat
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 Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp
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 Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp
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. Requisition Job Description Position Summary The Director, Corporate Affairs Technology leads the strategy, delivery, and operations of technology solutions supporting Legal, Compliance, and Corporate Security functions. This role partners with Corporate Affairs leadership to enable regulatory compliance, risk management, and enterprise protection through modern, scalable, and AI-driven technology solutions. This position is a leader-of-leaders role , with direct oversight of Senior Managers and their teams, and is accountable for delivering business-aligned outcomes across the Corporate Affairs application portfolio. Key Responsibilities Define and execute the technology strategy and multi-year roadmap for Corporate Affairs (Legal, Compliance, Corporate Security) Serve as a strategic partner to business leadership, aligning technology solutions to legal, compliance, and security priorities Lead and develop Senior Managers and their teams , ensuring strong performance, accountability, and organizational growth Own the end-to-end application portfolio , including design, delivery, operations, and modernization of platforms Champion AI, automation, and advanced analytics solutions to transform legal, compliance,
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 Risk Management is charged with protecting company assets. This group is responsible for minimizing risk – in legal, financial and operational areas – and its affects on the organization, as well as for enforcing security and safety measures. Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances. Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals, complaints and grievances for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals, complaints and grievance. Responsible for day-to-day implementation of Aetna's appeals, complaints and grievances policies and procedures. Identifies trends and issues; reports on and recommends solutions. Accountable for meeting the financial, operational, and quality objectives of the unit. -Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns. -Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation req
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 Purpose and Summary: Accountable for Commercial, Medicare, Exchange and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation. This role focuses primarily on Delegated Credentialling and Oversight of the delegated Credentialling organizations, per contract. Proactively builds strong business relationships with internal and external business partners. Participates in presentation to business partners on accreditation requirements to achieve results and ensure accreditation readiness. Proven experience as a subject matter expert on NCQA accreditation standards, analysis, Delegated Credentialing file reviews and supporting quality functions. Primary Job Duties & Responsibilities: Utilizes statistical analysis, data visualization tools, and database queries to identify trends, patterns, and opportunities for quality improvement. Develops and maintains performance metrics and dashboards to track and report on patient safety, clinical effectiveness, patient experience, and compliance with quality standards. Contributes to quality improvement projects and initiatives by providing data-driven insights and recommendations. Collaborates with cross-functional teams to design and implement evidence-based practices, care protocols, and process improvements. Assists in conducting audits and performing chart review
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 Revenue Integrity is seeking a Lead Director, Informatics (Performance Reporting & Insights) to lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions. This role transforms complex clinical, operational, and risk adjustment data into actionable insights that will drive provider performance, program efficiency, and executive decision-making. This leader will be responsible for creating action through data storytelling, advanced visualizations, and helping to advance the organization’s reporting strategy through AI and automation. This This role is customer-facing and will provide thought leadership and vision partnership to areas such as Market leads, Finance, Clinical, and Operational partners. The leader must also provide technical guidance to staff on BI tool input modeling and calculations. Key Responsibilities Risk Adjustment Performance Reporting Accountable for timely and accurate sharing of risk adjustment KPIs, trends, and performance drivers at a market, plan, and provider level through dashboards and reporting tools Quantify drivers of risk movement and surface those insights to business leaders for action Assess performance against operational and organizational objectives, including appropriate benchmarking and goal setting <
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 Manager - Process Engineering leads high-impact process improvement and Business Process Management (BPM) initiatives across Information Security and Technology Solutions (ISTS). This role is accountable for enabling operational excellence by designing, standardizing, improving, and governing ISTS processes using agentic workflows, Lean Six Sigma, and Business Process Management disciplines. The Manager- Process Engineering serves as both a delivery leader and capability builder, ensuring that ISTS has well-documented, measurable, and continuously improving processes with clear ownership, performance indicators, and controls. This role partners closely with technology tower leaders, Experience Owners, Process Owners, and risk, security, and compliance stakeholders to reduce operational friction, increase capacity, mitigate risk, and strengthen enterprise controls. Key Responsibilities: Apply DMAIC and Lean Six Sigma methodologies to solve complex, cross‑funct
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 It’s an exciting time for our Medical Economics team at CVS Health. As a growing team in a Fortune 5 company, we can provide amazing benefits to our employees along with continuous career development. This includes flexible work location, a great work-life balance, and a competitive salary. You will also be able to flex your analytics and consultative skills to positively impact our patients’ health. As a Medical Economics Sr Analyst, you will provide consultative support and medical cost-based analysis of markets and network initiatives. You will be responsible for consulting with network and clinical management on opportunities to improve our company’s discount position and strategic cost and utilization initiatives and is essential to managing conflicting priorities and multiple projects. As part of the Medical Expense Review (MER) team, you will prepare for monthly presentations, and manage both long and short-term projects, working collaboratively with local market leaders to accomplish tasks and goals that will improve the care we give our patients. You will also: • Analyze and research utilization and unit cost medical costs drivers • Turn data into usable information by telling the story through data visualization • Support the development of scoreable action items by identifying outlier cost issues • Perform drill-down analysis to identify 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 ** Candidates MUST live in the state of CA, and be a licensed pharmacy technician with the CA Board of Pharmacy (BoP). ** The Pharmacy Technician – Clinical Support Services position is responsible for utilizing their clinical knowledge and excellent customer service skills to provide our patients with the smooth service and delivery of medication and supplies to their homes. You will make a difference by bringing your personal touch and clinical experiences that will support our patient’s one on one care. Coram CVS/specialty infusion is a national leader in the home infusion field. As part of the team, you will have an important, uniquely rewarding role putting your Pharmacy Technician skills and experience to work in a closed-door practice setting. Responsibilities • Partner closely with pharmacists to coordinate and process new patient referrals, prescription renewals, and ongoing refill management. • Serve as a primary point of contact for patients, <spa
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. Registered Nurse (RN) - Utilization Management Location: Remote (Preference for candidates in Central or Eastern Time Zones) Schedule: 24/7 operation; includes evenings, weekends, and holidays Are you an experienced Registered Nurse looking to leverage your clinical expertise in a collaborative, fast-paced environment? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, high-quality healthcare services across the continuum of care. What You'll Do Review and assess clinical information to support coverage determinations and care recommendations. Apply clinical guidelines, policies, and professional judgment to utilization management decisions. Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans. Identify opportunities for care management referrals and enhanced member support services. Promote quality outcomes, effective healthcare utilization, and member-centered care. Serve as a clinical resource for internal and external stakeholders. Required Qualifications Active, unrestricted RN license in your state of residence. 2+ years of RN experience in adult acute care or critical care settings. Associate Degree in Nursing (ADN). Strong communication, critica
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, Senior Decision Scientist serves as a strategic analytics and ideation leader supporting Payment Integrity Affordability initiatives with a primary focus on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs. This role provides leadership and guidance to a team of Decision Scientists while driving the development, evaluation, and implementation of innovative opportunities that improve affordability outcomes and strengthen Payment Integrity capabilities. The Lead Decision Scientist is responsible for establishing analytical frameworks, managing ideation pipelines, defining success metrics, and identifying cross-functional opportunities that create enterprise value across Payment Integrity programs. Required Qualifications 7+ years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5+ years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy
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