Senior Manager, Payer Insights and Analytics

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

CVS Health is on a mission to transform healthcare.  With a shared purpose to help people on their path to better health, we are finding new ways to care for our communities, leveraging our brick-and-mortar footprint of 10,000 stores.  At the heart of this strategy are the 180,000+ store colleagues who build unmatched human connections with our customers every day.  As we seek to simplify a complex healthcare system for the patients we serve, while delivering disruptive innovation at a rapid pace, thoughtful communications that engage, inspire, and activate our colleagues across multiple channels are increasingly essential. 

The Senior Manager, Payer Insights is the foremost authority on Retail adjudication business intelligence and is relied upon to establish strategies to improve business performance by analyzing pharmacy claims data, identifying dispensing patterns, and evaluating payer reimbursement rates.  As the proprietor of NCPDP adjudication data, the Senior Manager’s focus is to serve the analytical/business intelligence needs of various enterprise stakeholders and leverage those capabilities to identify opportunities for billing simplification as well as margin saving insights specific to third party payer adjudication to optimize payer reimbursement.  Insights derived will drive informed business decisions and solution development related to the adjudication of pharmacy claims.   In addition, the role is responsible for providing objective and professional guidance to drive strategic recommendations that will incrementally improve business outcomes. The Senior Manager will work closely with a cross-functional team charged with identifying and generating significant value tied to workflow efficiency, margin improvement, and new business growth.  This will entail supporting various value-driving initiatives, as well as leading the design, implementation, and post-delivery monitoring of select adjudication and margin-related projects.     

The ideal candidate will possess outstanding analytical and problem-solving skills, and have experience presenting to Senior Leaders with poise and credibility.  They will have demonstrated success conducting complex quantitative analysis and building models using advanced analytical tools and platforms, and have the ability to communicate effectively and succinctly, both verbally and in content creation (e.g. Microsoft PowerPoint).  This Senior Manager will have experience managing and prioritizing multiple assignments while meeting deadlines, the ability to develop effective cross-team working relationships, a strong understanding of Payers, drugs, and the Retail pharmacy financial landscape, and capacity to work independently and adapt to evolving work priorities.  Equally important, this candidate will need to be a creative, out-of-the-box thinker who is intellectually curious with a demonstrated interest in learning, while maintaining an open and honest communication style that quickly builds trust and respect.

The Senior Manager will report to the Director leading the Performance Team, and lead a team of adjudication/analytics experts.

PRIMARY DUTIES AND RESPONSIBILITIES:

Responsibilities (% Time)

• 25%: Retail pharmacy claims adjudication data stewardship, including maintenance of back-end data infrastructure, tables, and schema, oversight of analytics/business intelligence requests from enterprise stakeholders, development of self-serve on-demand insights tools/platforms, and design/implementation of new data analytics programs to support emerging business opportunities 

• 25%: Drive value opportunity identification, engaging cross-functionally with internal/external business stakeholders to surface adjudication, workflow, and margin opportunities across Payers through rigorous analysis and research, and building appropriate business cases to influence operational priorities and gain executive leader support

• 25%: Lead the design, development, implementation, and monitoring of billing solutions that deliver value for customers, colleagues, and the enterprise—working cross-functionally to prioritize, structure timelines, develop project plans, align stakeholders, and incorporate feedback in service of driving successful outcomes

• 15%: Lead the development of a near and longer-term analytics/business intelligence strategic roadmap, taking inputs from multiple sources to influence internal and external stakeholders in the creation of novel solutions and programs which target emerging healthcare / billing opportunities

• 10%: Lead a team of adjudication/analytics experts, focusing on delivery against financial goals, setting of team priorities, commitment to on-going talent development, and maintaining a people-first culture of trust and collaboration

Required Qualifications

• 7+ years of analytical experience within pharmacy, healthcare, managed care, or related field
• 7+ years of experience with pharmacy claims adjudication
• Attention to detail, strong drive to ensure the integrity of underlying data and reports
• Ability to communicate and influence mid-level managers (Director and above), as demonstrated by 2+ years of experience creating and delivering leadership-facing materials and presentations
• 2+ years of experience using advanced Excel, PowerPoint skills and other MS Office Applications

Preferred Qualifications

• Experience in finance and margin analysis
• Mastery of Microsoft Office Suite, especially Excel, Access, and Powerpoint
• 8+ years of experience working with DW NCPDP or other BI data mining tools
• 8+ years of experience with the NCPDP standard
• 1+ years of experience leading a team of analysts

Education
Bachelor's degree required, Masters / Advanced degree preferred.

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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