Job DescriptionThe Senior Manager Client Benefits QA Health Plan Government unit is responsible for managing the day-to-day operations and delivery of a team of 10-15 Benefit associates analysts, specialists, vendors and Advisors engaged in designing & delivering test design and execution for its health plan clients. This position:
• Plans, directs, supervises and helps evaluate workflow and coordinate work activities to achieve the service level goals, quality and productivity as required. Accurate forecasting and resource management is critical.
• Define, manage, and deliver enterprise-wide QA processes, strategies, and controls across the PBM testing portfolio. Develop, implement, and maintain QA standards and reviews to monitor quality of delivery
• Recognizes and recommends operational improvements including automation. Define and measure quality metrics and act upon data for continuous improvement
• Monitors the performance of staff members and vendors according to established monitoring standards.
• Work cross functionally with all benefits departments including configuration, networks, clinical, implementation, account management etc
• Manage benefit QA operations including assessing, planning, developing, executing and monitoring QA strategy on Requirements gathering, coding and testing.
• Set team direction, resolve problems and provide guidance to members of the team to ensure they meet the established performance metrics and goals. Serve as a coach, mentor and advocate for staff in their development and training.
• Participate in client meetings. Understand client expectations, monitors client operations dashboard measures to proactively manage client-level impacts.
•Identify, plan, and manage process improvement projects to create year-over-year efficiencies in operational workloads. Define /revise the Policies and procedure as needed.
•Manages quality issues in requirements, coding and testing through the work flow management system and collaborates with testing, coding and the Business Relationship Managers to manage the defect resolution work flow.
•Take a lead role in developing and participating in new program initiatives and innovations. Adapt departmental plans and priorities to address business and operational challenges.
Required Qualifications• 5+ years of management experience in a business operations function, with focus on quality or testing of client benefits either in a PBM industry or Managed Care
• 3+ years of Vendor Management experience
Preferred Qualifications• Experience with third party prescription/medical payment and/or claims adjudication systems desired EducationBachelor's degree is required; equivalent work experience may substitute. Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
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CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/