Sr. Manager - Payment Integrity

CVS Health • Hartford, OK

1d • Hybrid

About The Position

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 Lead and advance the Payment Integrity program by overseeing a multi‑functional team responsible for identifying, evaluating, and developing mis‑payment claim opportunities across multiple lines of business and claim platforms. Build and sustain strong partnerships with stakeholders across the HealthCare Business to foster collaboration, support idea generation, and strengthen development pathways. Oversee the design and implementation of reporting dashboards that inform strategic planning, concept ideation, and program growth. Develop staff that maintains the integrity of claim data, manages Payment Integrity processes and ensures compliance with CVS and claim policies and procedures. Provide leadership, coaching, and direction to staff, driving results while delivering exceptional service to internal business partners. Champion operational excellence by pursuing innovative approaches that enhance program performance. Translate complex analytical challenges into meaningful insights and recommendations, ensuring information is communicated in a way that is accessible and impactful. Develop and maintain measurement frameworks and reporting dashboards that assess current and forecast future-state performance. Deliver timely, validated, and actionable data‑driven insights to support program decision‑making. Effectively communicate analytical findings and key performance metrics in a clear and compelling manner. Purpose of the Payment Integrity program: Reduces medical costs by generating, intaking, and performing extensive analysis and investigation to accurately identify incorrect claim payments prior to and after claim payment. Our program is crucial in the prevention of underpayments and overpayments which reduce member and provider abrasion. We support liberalizations, non-standard contracts and benefit plans to fill in the gaps of incorrect claim considerations by the claim system and processors.

Requirements

• Healthcare experience.
• Must have experience managing staff greater than 10.
• Some knowledge of writing SQL using various software such as SAP Business Objects (WEBI), Google Cloud Platform (GCP), Crystal Reporting, etc.
• Experience creating reporting dashboards in platforms such as: Power BI, Tableau
• Experience with MS Office Suite
• Demonstrated experience in planning and making data-driven business decisions, such as volume trending analysis.
• Mastery of strong analytical, problem-solving, and decision-making skills, with the ability to drive innovation and continuous improvement.
• Facilitates risk assessments and monitors control measures to safeguard claim and program integrity and mitigate risks.
• Developing procedures to streamline processes, automate manual tasks, and enhance operational efficiency.
• Create forecasting processes, ensuring accuracy and alignment with strategic objectives.
• Experience conducting performance evaluations, setting performance goals, providing guidance, and fostering a collaborative and high-performing team environment.
• Proven track record of taking the initiative and displaying persistent determination to overcome roadblocks through creative solutioning of complex issues and data difficulties.
• Proven track record of successfully mentoring team members.
• Experience creating and maintaining SOPs; working across teams to identify best practices, streamline processes with seamless handoffs between teams.
• Implementation of automated solutions to repetitious work.
• Proven track record of consistently providing best in class customer service in collaborating with business partners enterprise-wide to gather data and support strategic initiatives.
• Master of communication; ability to communicate effectively in a clear, logical, and consistent manner with all audiences, with varying levels of technical background.
• Ensure successful end-to-end execution and impactful outcomes.
• Experience defining quality standards, re-evaluating and adjusting as appropriate.
• Mastery of growth mindset (agility and developing yourself and others) and intellectual curiosity.
• Proven track record of meeting deadlines with multiple competing priorities of varying TATs.
• Strong time management and organizational skills.

Responsibilities

• Lead and advance the Payment Integrity program
• Oversee a multi‑functional team responsible for identifying, evaluating, and developing mis‑payment claim opportunities across multiple lines of business and claim platforms.
• Build and sustain strong partnerships with stakeholders across the HealthCare Business to foster collaboration, support idea generation, and strengthen development pathways.
• Oversee the design and implementation of reporting dashboards that inform strategic planning, concept ideation, and program growth.
• Develop staff that maintains the integrity of claim data, manages Payment Integrity processes and ensures compliance with CVS and claim policies and procedures.
• Provide leadership, coaching, and direction to staff, driving results while delivering exceptional service to internal business partners.
• Champion operational excellence by pursuing innovative approaches that enhance program performance.
• Translate complex analytical challenges into meaningful insights and recommendations, ensuring information is communicated in a way that is accessible and impactful.
• Develop and maintain measurement frameworks and reporting dashboards that assess current and forecast future-state performance.
• Deliver timely, validated, and actionable data‑driven insights to support program decision‑making.
• Effectively communicate analytical findings and key performance metrics in a clear and compelling manner.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager