Plymouth, Minnesota

Job Description
Maintains oversight of functions in PBM Operations for the following teams: invoice processors, data integrity/accumulator audits, and file management which includes implementations, IT Agile/UAT, and vendor management.  Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Plans, directs and implements procedures that will assure a high level of customer access and satisfaction. Responsible for the quality and effectiveness of own team and related teams, identifying and resolving technical, operational and team problems. Manages a team of professional employees.Oversees PBM Operations that consists of three units that perform the following functions:1) File ManagementActs as the PBM vendor liaison and subject matter expert for eligibility and accumulator filesAgile Team product owner role Submits IT tickets and performs UAT for new implementations and issue resolutionPerforms research on file issues and partners with IT on resolution2) Data Integrity TeamIntakes and processes PBM call referralsConducts plan set-up audit from over-applied reports Coordinates plan set-up corrections/updates with Plan Build Team and/or PBM vendorIdentifies adjustments for member accumulators and routes to Adjustment Team for processing3) Invoice Processor TeamImports PBM claims data and invoicesReconciles and balances claims data and invoicesCoordinates client billing and invoice payments with Client AccountingEffectively applies and enforces Aetna HR policies and practices, i.e. FML/EML, Attendance, Code of Conduct, and Disciplinary Guidelines. Effectively manages cross-functional projects that support the business strategy.

Required Qualifications
5+ years’ experience in managing high volume transaction processing, project delivery, production, implementation, audits, and UAT.Demonstrated issue resolution.Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.Proven strong leadership skills managing large high performance teams.Healthcare experience preferred.Experienced working with vendors.PBM Operations experience.Bachelor's degree or equivalent combination of education and experience.

Preferred Qualifications
Please review required qualifications above

Education
Bachelor's degree or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Plymouth, Minnesota

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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