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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

CVS Health is currently looking for a dynamic individual to join our team in a Manager role. In this client facing project management role, you will be responsible for coordinating, managing and assisting with audits and using broad and deep system set-up and adjudication knowledge. In this position you will work closely with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas to ensure the completion of government audits with consistency and minimal disruption to the business. Additionally, you will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process and to improve, develop and deliver on automation projects and complex analyses specifically related to audit deliverables. This position will also be expected to be analytical, able to understand regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and respond to all the auditor questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.

As a Manager of Client Audit, you will be responsible for the following:

· Work directly with the government auditors, the client and all the internal business areas involved in the audit

· Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities

· Have a deep knowledge base of Medicaid and Exchange regulations, as well as having some knowledge around Med D

· Work independently with limited direction from the Sr Manager

· Coordinate, manage, track the audits from start to closure

· Review and research all questions from the auditor and client

· Work through and resolving any alleged issues; working strategically and achieving results

· Work with the right business leaders to ensure responses are accurate and senior leaders are aware of any issues in accordance with regulatory timelines

· Respond back to the auditor / client

· Understand the intricacies of claim adjudication in order to answer questions related to the various claim testing sections, answering their questions correctly and confidently

· Identify process enhancements, as well as any gaps in controls within the business areas being audited

· Raise the appropriate items to senior leaders and doing so timely

· Documenting correspondence with internal partners, clients, and auditors

· Tracking all audit progress to ensure that all deliverables are provided by due dates

The ideal candidate will possess the following:

· A deep understanding of pharmacy claim adjudication

· Ability to actively seek new ways to grow and be challenged

· Critical thinking which translates into strategic actions

· Easily adapting to change

· Excellent verbal and written communications skills and experience communicating/presenting with all levels of leadership

· Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each project’s success.

· Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress

· Strong ability to maintain attention to detail and organizational skills.

· Team building skills that effectively influence and engage others in issue resolution-demonstrates pro-activeness looking out for the success of the team and CVS Health.

· Solves complex problems; takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information

· Uses best practices and knowledge of internal or external business issues to improve products or services

· Strong ability to hold oneself and others accountable for mitigating risk and achieving results.

Required Qualifications

5+ years of prior relevant experience in audit, project management, or financial advisory role

3+ years pharmacy claim experience

Preferred Qualifications

- CPA, CIA or MBA preferred

• Medicaid operational experience

• Internal or external audit experience

• Demonstrated excellent verbal and written communications skills.

• Proficiency in Microsoft Word, Excel, PowerPoint

• PBM Experience is also desired

Education

BS/BA required or equivalent years of education and experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $132,600.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 04/30/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.