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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

This position serves as a subject matter expert and independently coaches others on appeals and grievances inventory monitoring ensuring compliance with Federal and/or State regulations. Interacts with external vendors, external consultants, consulting team members and/or matrixed staff as required in development of audit initiatives. Develops and supports transferring inventory knowledge, best practices (external and internal), methodology and tools to client organizations. Participates as a team member, may participate in concurrent audit initiatives based on resource requirements. Position conducts a review and ensures timely completion of inventory monitoring for each plan in their assigned region and trend opportunities for improvement, independently investigate, report results to oversight leadership and staff.

Develops and supports thorough A&G inventory review and value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions) and alerts leaders of identified opportunities for improvement.

Participates in and supports metrics integration and execution for optimal results through individual inventory and plan level audits. Supports engagement using a disciplined repeatable methodology.

Communicates compelling and concise results to empower health plans in decision making process regarding A&G inventory opportunities and supports initiative planning as required and Initiates and encourages open and frequent communication, between constituents, to dissect policies, trends, and workflows, in turn identifying areas in need of inventory improvement, throughout various departments.

Gathers, analyzes and synthesis business intelligence to drive inventory achievement business objectives. Independently takes complete ownership of their responses as their inventory monitoring findings may result in mitigating negative publicity or stopping the trigger of an external audit or fine.

Required Qualifications

Medicaid experience is REQUIRED; Medicare experience preferred.

3-5 years experience as a Complaint, Grievance and Appeal Analyst, Sr. Analyst, or Consultant

Preferred Qualifications

Experience as an assistant Team Lead, Team Lead or Project Manager is a plus

Knowledge of ICD-9 and CPT codes desired.

Education

Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $91,800.00

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: 05/31/2025

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.