Payment Integrity Jobs Near Me

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.

The Senior Manager - Business Consulting, within the Payment Integrity Center of Excellence (PICOE) team, will help formulate, lead, and champion strategic initiatives in partnership with vendor partners, senior leaders, internal stakeholders across the enterprise, and/or key business partners. Initiatives may range across operational change, new uses of analytics and technology, process standardization, enhanced customer service, and more. Length of project(s) may run multiple months or years in duration.

This position will require continuous collaboration and consultation with vendor partners, leaders, contributors, and various level stakeholders to ensure the desired business outcome is defined and achieved. The ideal candidate is an initiative-taker, detail-oriented, highly organized, and able to work on multiple tasks simultaneously in a fast-paced and ever-changing environment.

This role involves complex, cross-functional stakeholder management and significant exposure to leadership. It requires a strong background in complex program management, business or healthcare consulting, or strategic planning and process improvement, with demonstrated ability to work independently, build collaborative relationships, communicate clearly, gain alignment and consensus, build comprehensive execution plans, and meet difficult deliverables in a dynamic environment. It also requires openness to diverse and often ambiguous objectives, with a proven track record of facilitating and influencing teams, with and without authority.

The Senior Manager, Business Consulting, supports the business by recommending appropriate actions, strategies and/or alternatives to meet healthcare industry business needs. The candidate should exhibit the ability to identify and manage project implementation activities across the enterprise that includes increasing the contractual terms, reimbursement accuracy and performance of our claim editing vendors, proposing opportunities to lowering G&A (reducing appeals, claim rework, and provider settlements), maximizing revenue, centralizing vendor data accuracies and service level agreements, and improving overall consistency and credibility of our Payment Integrity programs.

• Leads monthly invoice/payment reconciliation and associated metrics for vendor reimbursement
• Acts as an advocate for change, influencing others to see the value in project and/or processes; driving innovative and realistic solutions that align to CVS Health's strategic direction.
• Manages the work and deliverables of multiple, complex projects or programs, through ideation to implementation; that impact multiple processes, systems, functions, services, and/or products.
• Cohesive project facilitation, planning, collaboration, analysis, and guidance, ensuring that solutions achieve the expected business benefit or result.
• Active participation in all phases of the program management processes: which may include discovery, assessment, initiation, planning, design, development, testing, execution, deployment, post implementation support etc.
• Ensure business requirements are defined, documented, and interpreted to meet stakeholder interests; and successful delivery of project end-state that meets business objectives and intended outcome(s).
• Proactively manage, escalates and mitigate all issues and risks, engaging required parties, and escalating as needed, to drive to resolution and project deliverables remain on track.
• Conduct root cause analysis in support of the business by recommending appropriate actions, strategies and/or alternatives to address business challenges.
• Understand implications of proposed solutions or process changes and supply guidance on alternatives where necessary.
• Track activity progress and build communication plan for implementation to ensure all impacted parties (up-stream/down-stream)are informed of next steps for completion and project status.
• Effectively manage team/stakeholder expectations and engagement through clear and frequent communication regarding status updates, critical path progress, and variances from project plan.
• Develop and participate in presentation and consultation with business partners on capabilities, performance results and can perform reasonability checks.

• 5+ years related experience in project/program management, policy (financial analysis, forecasting and/or procurement/sourcing) associated with external Payment Integrity Vendors
• 5+ years of direct project/vendor management experience; managing medium-to-large-scale, cross-functional projects
• Financial/Operational Metric and Performance Analysis and Vendor Contractual Acumen
• Experience includes development and management of multiple projects and/or programs, simultaneously
• Self-starter with the ability to work independently and effectively prioritize multiple deliverables
• Demonstrated flexibility to manage conflicting priorities and multiple projects concurrently
• Proven track record in meeting deadlines, assigned deliverables, project milestones, and negotiating for resources
• Expert problem-solver who is an analytical critical-thinker with ability to execute remediation plans
• Ability to influence, collaborate, and communicate effectively with all levels and varying audiences
• Systems-thinker, willing to challenge the status quo, to generate innovative solutions, and drive change
• Demonstrated success using verbal and written communication skills to present information

• Ability to interact with others in a collaborative and professional manner while fostering teamwork and knowledge sharing to complete key tasks
• Strong presentation and communication skills with experience presenting to various business groups
• Aptitude to communicate complex findings and conclusions in an easy-to-understand way
• Strong organizational, multi-tasking, and follow up skills
• Ability to work independently in a fast-paced environment, manage tight deadlines, and competing priorities
• Experience with Health Rules Payer (HRP), QNXT (Medicaid), Medcompass, ACAS transaction system(s)
• Strong understanding of the various Aetna systems and the end-to-end provider/member experience operating model
• Prior healthcare and/or project management experience

• Bachelor's degree (business or technical) or equivalent professional work experience
• Project Management or Coder Certification(s) preferred

The typical pay range for this role is:

$67,900.00 - $199,144.00

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.

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.

We anticipate the application window for this opening will close on: 08/22/2026

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