Legal Case Manager

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
This position serves as a critical compliance and operational resource responsible for reviewing, researching, validating, and processing requests for member Protected Health Information (PHI). The role ensures compliance with HIPAA, applicable state privacy laws, regulatory requirements, and organizational policies by determining whether requests for access to, use of, or disclosure of PHI are legally permissible and properly authorized prior to the release of records. Responsibilities include supporting member rights requests, legal access requests, subpoenas, court orders, regulatory inquiries, law enforcement demands, and other authorized disclosures of health information

What you will do:

• Review, research, and process requests for member claims records involving Protected Health Information (PHI), ensuring compliance with HIPAA, state privacy laws, company policies, and regulatory requirements.
• Process and fulfill requests submitted to Aetna seeking access to member Protected Health Information (PHI), ensuring all legal, regulatory, privacy, and authorization requirements have been satisfied before records are disclosed.
• Review and validate request documentation to determine eligibility for disclosure and confirm compliance with applicable federal and state regulations.
• Manage and process requests received through:
  • Subpoenas and court orders
  • Law enforcement requests and demands
  • Regulatory agency inquiries and requests
  • Legal Access requests
  • Member and provider authorizations
  • Personal representative requests
  • Other legally permitted disclosures of Protected Health Information
• Research and resolve complex or non-routine member rights, disclosure, and privacy requests, escalating matters requiring legal, compliance, or privacy review.
• Ensure confidentiality and security of sensitive member information while adhering to established policies, procedures, and internal controls.

Required Qualifications

• Working knowledge of problem solving and decision making skills
• 2-5+ years’ work experience with Protected Health Information (PHI)
• Excellent verbal and written communication skills

Preferred Qualifications

• Working knowledge of HIPAA Privacy Rule requirements
• Experience reviewing and interpreting legal documents, subpoenas, court orders, authorizations, and regulatory correspondence

Education

• High School Diploma or Equivalent Experience (REQUIRED)

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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