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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.

A Brief Overview

Provides strategic leadership and oversight to ensure exceptional customer claim experiences and satisfaction by developing and implementing service strategies, managing a team of customer service representatives, monitoring service quality and performance metrics, resolving escalated customer issues, and implementing customer service training programs. Applies leadership skills, customer-centric mindset, and problem-solving abilities to drive customer loyalty, retention, and advocacy while promoting a positive and service-oriented culture within the organization. Through structured provider engagement and claims payment review discussions, the role secures resolution of open inquiries and issues, elevates areas of ongoing opportunity to key cross-functional partners, and contributes to an overall improved provider experience.

What you will do:

· Develops / maintains effective working partnership with appropriate points of contact within key health system partners related to revenue cycle, accounts receivable management, and contracting as appropriate

· Develops strategies to optimize service operations, ensuring the efficient and effective delivery of services to meet customer needs and expectations.

· Implements industry best practices and proven methodologies to streamline service processes and improve operational efficiency.

· Evaluates, selects, and integrates innovative technologies and systems to optimize service operations and enhance customer support efforts.

· Oversees all claims through completion within defined SLAs and holds stakeholders accountable for closing/advancing claims within established SLAs.

· Manages and allocates resources effectively to ensure that services are delivered efficiently, on time, and within budget.

· Develops and monitors key performance indicators (KPIs) to measure service performance, ensuring that the services provided meet the established quality standards and customer expectations.

· Fosters a customer-centric culture, emphasizing empathy, effective communication, and problem-solving skills in all customer interactions.

· Focuses on customer satisfaction and retention by monitoring customer feedback, addressing complaints, and implementing measures to enhance the customer experience.

· Communicates strategically with IT and data management teams, leveraging technology and data analytics to optimize service operations, improve efficiency, and enhance customer insights.

· Stays updated on industry trends, emerging technologies, and best practices in service operations, incorporating relevant knowledge into operational strategies and driving innovation in service delivery.

For this role you will need Minimum Requirements:

· 5-7 years of experience in claims / provider operations

· 3-5 year of experience with managed care claims processing and/or provider payment dispute resolution and relations

· Prior experience leading cross-functional operational workflows with SLAs

· Strong written, verbal, and project management skills, including provider-facing discussions

· Ability to drive accountability across multiple stakeholders and resolve dependencies in a high-urgency environment

Education

· Bachelor's degree preferred/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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. This position also includes an award target in the company’s equity award program.

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 05/02/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.