Job Details

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary

Acts as the primary resource for assigned, high-profile providers or groups (i.e., local, individual providers, small groups/systems) across multiple markets/states to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

1. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
2. Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related to claims payment, contract interpretation, or provider demographic information are resolved.
3. Supports or assists with operational activities including database management and contract coordination.
4. Performs credentialing support activities as needed.
5. Educates providers to ensure compliance with contract policies, plan design, compensation processes, technology, policies, and procedures.
6. Meets with key providers periodically to ensure service levels meet expectations.
7. Manages the development of agendas, validates materials, and facilitates external provider meetings.
8. Collaborates cross-functionally on the implementation of products, contracts, or provider demographic updates.
9. Serves as a subject matter expert within the team for progress, program overviews, and state-specific contractual requirements.
10. Responsible for onboarding new staff and facilitating ongoing training.
11. Attends and interacts with external/state facilitated calls, working sessions, and Joint Operating Committees.

Required Qualifications

• Strong knowledge of business segment-specific codes, products, and terminology.
• 3-5 years experience with business segment-specific policy, benefits, plan design, and language.
• Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills.
• 3-5 years in external-facing customer service working with providers.

Preferred Qualifications

3+ years' experience in a business segment environment servicing providers with exposure to benefits and/or contract interpretation.

Education

Bachelor's degree in business, healthcare, communications, or related area is preferred. Recent experience as a provider relations representative, member service representative, or relevant claims experience is highly preferred but not required.

Additional Details

Anticipated Weekly Hours: 40

Time Type: Full-time

Pay Range: $54,300.00 - $119,340.00

This pay range represents the base salary or hourly rate. The actual offer depends on experience, education, geography, and other factors. This role may include bonuses, commissions, or incentives.

Our people fuel our future. We are committed to fostering a workplace where every colleague feels valued and belongs.

Benefits

Our comprehensive benefits include:

• Affordable medical plans, 401(k) with matching, and stock purchase plans.
• No-cost wellness programs, counseling, financial coaching.
• Flexible work schedules, paid time off, family leave, dependent care resources, tuition assistance, and more.

For more information, visit

Application deadline: 05/16/2025

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.