Job Title

Job DescriptionThe Manager of Adjustment Services - Express leads a team that adjusts claims by reprocessing them through the adjudication system. This activity touches millions of claims a year and is used to address benefit coding errors, eligibility changes, program features, and client requests. A successful candidate will enjoy leading a team that manages multiple projects in a fast-paced, process-driven environment. The person chosen for this position will possess excellent communication and time-management skills. In addition to communicating directly with Sr leadership, this team will work closely with Sales, Account Management, IT, Medicare Part D Services, Benefits, and Implementation teams to manage and coordinate the work.Responsibilities include but are not limited to: -- Consistently review processes to identify areas of process improvement and opportunity and ensure all documentation is continually updated and made available-- Diffuse and manage escalations with difficult clientele, including the ability to join external calls as well as working with external partners-- Work alongside team members who are engaged with automation efforts-- Serve as a subject matter expert for key aspects of the R&R process-- Project manage various claim reprocessing projects that fall outside the normal process flow scope-- Manage the Pharmacy Adjustment Process as well as Service Warranty projects associated with PG-related ClienteleRequired Qualifications5+ years of work experience in the healthcare industry5+ years experience leading and/or managing a teamCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications-- Cross functional PBM knowledge-- CVS Caremark PBM adjudication/system knowledge, AS400, and adjustment logic-- Project Management-- Excel, including the ability to manage and present large volumes of data via creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions-- Deliver formal presentations to a wide range of audiences-- Create and monitor controls to ensure accurate financial impacts are issued-- Pharmacy Claims Adjudication-- Reverse and Reprocess (R&R) and/or corrective adjustment process-- Excellent verbal and written communication skills-- Communicate with exceptional customer service skills to both internal and external customersEducation-- Bachelors degree or equivalent experience required-- Degrees in Finance, Accounting, or other business degrees strongly preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.