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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) across multiple markets/ states to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.

- Monitors service capabilities and collaborates cross- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.

- Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.

- Performs credentialing support activities as needed.

- Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.

- Meets with key providers periodically to ensure service levels are meeting expectations.

- Manages the development of agenda, validates materials, and facilitates external provider meetings.

- Will collaborate cross-functionally on the implementation of products, contracts or provider demographic updates

- Sought out as a subject matter expert within the team for progress, program overviews, and state specific contractual requirements

- Responsible for onboarding new staff, facilitating on-going training

- Position will attend and interact with external/state facilitated calls, working sessions and Joint Operating Committees

Required Qualifications

Strong knowledge of business segment specific codes, products, and terminology

3-5 years experience with business segment specific policy, benefits, plan design and language

Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills

3-5 years in external-facing customer service working with providers

Preferred Qualifications

Preferred Qualifications:

3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation

Education

Bachelor’s degree in business, health care, communications, or other related area is preferred. Recent experience as a provider relations representative, member service representative, or relevant claim experience is highly preferred, but not required

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/16/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.