Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
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

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

What you will do

Negotiate single case agreements for episodes of care on a pre-service basis.

• Participation/engagement of looking at forecasts changes within the Contract Negotiations industry, development of business impact assessments, and modification strategies with the aid of process improvement methodologies.
• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities
• Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets within Aetna.
• Coaches more junior colleagues in techniques, processes, and responsibilities.

Required Qualifications

• Experience in provider contracting, claims management patient management and with Aetna systems (Smart Front End, ASD, ATV, HRP, MedCompass. RUMBA – EPDB, EWMP, Rate Inquiry, Contract Inquiry) is preferred. 
• 2-4 years’ experience working with/or in a Claims environment.
• 1-2 years’ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management; provider relations or claims management. 

Preferred Qualifications

• Knowledge/experience with National Advantage Program within Aetna.

Education
Bachelor’s Degree or 2-4 years relevant industry experience with provider negotiations and claims environment.

Pay Range

The typical pay range for this role is:

$54,300.00 - $145,860.00

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

We anticipate the application window for this opening will close on: 02/14/2025

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