Senior Manager Project Management

  • Management
  • Full time
  • 3 weeks ago
company profile image

CVS Health

Job Description

Location: United States
Category: Aetna
Job Type: Fully remote

Job Description:
Eligible to Apply Anywhere in the US
Provides production support for Medicare product and benefit and automation initiatives supporting increased AA and increased efficiency for updates to product and benefits and production plan moves.

Successful candidates will have a mix of product and benefits knowledge and use in claims adjudication processing. If your goal is to combine your strong Medicare product/benefits knowledge, with your analytic and technical implementation skills, then this is the ideal job for you.

You will determine the best approach for driving the desired benefit outcomes in claims processing and provider payment. Experience with coding standards, ICD 10 and CPT codes would be beneficial. You will also need to evaluate the impact of CMS and state legislation on benefit plans. This is a unique opportunity to be on a dynamic team that is shaping the new delivery of healthcare.

Demonstrated analysis and critical thinking and skills, with strong knowledge of product and benefit plan configuration on a business owned and maintained platform. Ideal candidates understand the interaction of benefits, provider networks and claims adjudication outcomes.

  • Communicates product features and fundamental components to the organization that reflects the product and responds to the needs of various stakeholders (i.e., employees, customers, shareholders) while communicating the need and rationale for policies and standards.
  • Represents Medicare NextGen Product and Benefit Configuration capabilities and strategy in cross functional meetings and related project activities, e.g. Commercial Product and Marketplace Offerings for Individual bid filings, Legislative Review Committee, and Operational Support areas.
  • Collaborates with market segments to develop and implement plans and product features to achieve segment product strategies and achieve marketplace advantage.
  • Serves as project manager and/or participant for selected projects.
  • Independently manages mid-sized product enhancements, including defining new enhancement requirements and feature with the application vendor and testing and sign-off of delivered capabilities.
  • Ensures that the Product & Benefit configurations are designed, developed, implemented and maintained from a product and business/customer point of view.
  • Ensures maximum reusability across standard plans and offerings to enable efficiency and accuracy in delivery and speed to market.
  • Performs research and analysis on legislative, competitive and industry issues to recommend new products or product enhancements.
  • Participates in idea generation and project vision session for the development of new products and product enhancements.
  • Gathers and analyzes feedback in support of performance analysis for products and continual improvement.

Required Qualifications

  • 3-5 years experience with Project Management skills.
  • 2-3 years developing automation BOTS and/or databases
  • Knowledge of claim handling and associated processes such as provider contracting.
  • Strong analytical skills.
  • Proficiency with Excel.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • 2 years or more of experience with Health Rules Payor technology platform


  • BS and/or IT Certification
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