Jobs at CVS Health

Provides strategic healthcare regulatory counsel for digital products and services throughout the product development lifecycle. Drafts and negotiates agreements, reviews communications, identifies legal and business risks, and advises internal teams on healthcare laws, privacy, data use, interoperability, and digital technology. Supports mobile apps and online platforms, collaborates across legal and business functions, and applies regulatory frameworks to achieve business objectives.

Transforms data into actionable insights for CVS Health’s Direct-to-Consumer channels. Develops reporting solutions, quality dashboards, and analytics on agent behavior, quality trends, and process opportunities. Partners with Quality Assurance, Compliance, Operations, and Vendor Management to ensure data integrity and improve performance. Supports vendor oversight, internal reporting, and quality-monitoring innovation using tools such as Excel, SQL, and NICE CXone, with a focus on Medicare sales processes.

Lead and manage multiple, cross-functional enterprise marketing programs. Develop integrated marketing plans, timelines, and capacity forecasts. Apply PMO governance, drive stakeholder alignment, surface risks and mitigation, provide portfolio visibility, and improve PMO processes using program and portfolio management tools.

Lead cloud and data platform engineering for analytics and AI: implement DevSecOps CI/CD pipelines, automate infrastructure with IaC, manage Snowflake data warehouse and ingestion, oversee cloud cost reporting and FinOps, and evaluate/operate emerging AI/LLM capabilities and governance. Act as senior individual contributor collaborating with security, finance, and engineering teams to optimize performance, security, and cost.

Lead technical strategy for a 50–150+ engineer organization, establish architecture and engineering standards, drive delivery, and partner with executives on technology investments. Embed production-grade generative AI, LLMs, agentic workflows, and ML automation into engineering. Own AI platforms, distributed systems, cloud-native backend architecture, modernization initiatives, microservices migrations, and engineering transformation while ensuring scalable, reliable outcomes.

Leads strategic and operational initiatives across Southeast Medicare markets, translating territory priorities into workplans, milestones, governance processes, and execution paths. Coordinates alignment among market leaders, shared services, and enterprise partners; tracks decisions, risks, dependencies, and action items; escalates issues; and supports process standardization, continuous improvement, and consistent application of Medicare Advantage best practices.

Leads Group Retiree Solutions open enrollment strategy, operational execution, planning, training, performance tracking, dashboards, budgets, and cross-functional initiatives. Partners with account management, marketing, service operations, and business stakeholders to improve workflows, mitigate risks, monitor results, and implement process enhancements. Presents performance insights, drives consensus, and supports member experience and business objectives.

The Senior Manager, Sales Operations & Analytics oversees sales processes, drives operational effectiveness, and provides performance insights to enhance sales productivity and decision-making.

Leads the strategic vision, roadmap, and execution of the Health100 platform engineering organization. Oversees complex integrations, platform modernization, cloud migrations, engineering governance, architecture, delivery, talent development, vendor strategy, and stakeholder alignment. Guides multi-team initiatives across distributed systems, cloud-native technologies, and AI-enabled solutions while ensuring quality, operational reliability, measurable outcomes, and high-performing engineering teams.

Lead accessibility strategy and execution across product, design, and engineering. Drive audits, remediation plans, metrics, SLAs, training, and executive reporting to embed inclusive practices and remove digital barriers.

The Strategic Account Manager leads digital media campaigns, manages client and supplier relationships, and drives strategic planning, execution, and performance analysis to enhance business growth and achieve advertising goals.

The role involves leading a high-skilled tech team in modernizing CVS Health's Claims Adjudication platform through strategic development, integration, and execution of technology solutions.

Reviews and adjudicates routine medical claims, verifies eligibility and benefit coverage, applies coding and medical necessity guidelines, identifies discrepancies, and ensures accurate processing within turnaround requirements. Communicates with providers and members, investigates claims requiring additional review, handles correspondence, routes complex claims, and analyzes claims data for trends and process improvements.

Leads the strategic roadmap and value realization for CVS Health’s Clinical Insights Engine across screening, diagnosis, quality measurement, and care management. Partners with platform product managers, clinical leaders, business owners, and technology teams to integrate business priorities with platform capabilities. Oversees adoption, KPI monitoring, business-case development, stakeholder alignment, and continuous product improvement while ensuring measurable clinical and financial outcomes.

Supports cross-business strategy and operations for CVS Health’s Diversified Commercial Solutions organization. Responsibilities include managing financial and business-priority reporting cadences, leading cross-functional strategic initiatives, improving collaboration across a complex matrixed organization, and developing content for executive meetings and external events. The role partners with senior leadership to drive execution, transparency, growth, and operational accountability.

Processes healthcare benefit claims by reviewing documentation, verifying eligibility and coverage, assessing coding accuracy and medical necessity, documenting claim data, and resolving discrepancies with stakeholders. Conducts claim investigations, ensures regulatory and policy compliance, and analyzes claims data to identify trends and improvement opportunities. Supports feedback and performance review processes within the claims department.

Leads financial reporting, accounting, controllership, and close activities for Aetna’s Medicare Supplement business. Maintains reporting processes, internal controls, documentation, and SOX compliance while partnering with Finance, Actuarial, Operations, and business leaders. Drives process improvement, automation, analytics, system implementations, and reporting enhancements. Manages competing priorities, mentors team members, and promotes accountability and continuous improvement.

Leads enterprise Epic architecture for Healthy Planet, care coordination, STARS/HEDIS reporting, population health, and risk adjustment. Designs workflows and data models across Epic applications, Clarity, Caboodle, registries, reporting tools, payer data, and interoperability platforms. Translates CMS and NCQA requirements into Epic solutions, oversees integrations and vendors, mentors technical teams, and presents roadmaps to executive stakeholders. Requires extensive healthcare IT and Epic experience, population health expertise, and familiarity with value-based care, ACOs, FHIR, and HL7.

Supports senior account executives in managing large-group health plan clients and consultants. Responsibilities include resolving claim and eligibility service issues, tracking action items, leading client service calls, coordinating open enrollment activities, communicating updates, reviewing benefit documents and summaries, submitting SBC requests, and developing client relationships. The role gradually assumes independent ownership of increasingly complex service issues.

Reviews and reworks sensitive, complex medical and hospital claims for compliance, provider, network, and large-scale rework projects. Performs root cause analysis, researches claim issues, coordinates with appropriate teams, and resolves claims accurately by project deadlines while meeting quality and turnaround expectations.