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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

The Special Supplemental Benefits (SSB) team has an exciting new opportunity!  We are seeking a detail-oriented and collaborative Senior Manager to lead the business-side of the design, implementation, and oversight of benefit eligibility processes across multiple programs and systems. This position will play a critical role in taking business needs and translating them into technical solutions by defining requirements, working closely with internal stakeholders, program owners, IT teams, and external vendors to ensure eligibility processes are accurate, efficient, and aligned with business goals and regulatory requirements.  This position sits within the Medicare product business area, not on an IT team.

This role will be responsible for:

Serving as the business owner for eligibility processes across special programs, ensuring alignment with organizational goals and compliance standards.

Accountability for the successful implementation and operations of all SSB eligibility processes associated with the benefits/programs.

Partnering with the SSB program owners to define and document eligibility requirements ensuring alignment with business needs.

Collaborating with stakeholders across departments to understand current eligibility processes, identify pain points, and define future-state requirements.

Translating business needs into clear, actionable requirements for IT teams by gathering and writing business requirements, participating in the creation of technical specifications, participate in solution design discussions and leading cross-functional workgroups.

Overseeing the execution of eligibility and SSB benefit-related projects from a business perspective, including test planning, user acceptance testing and validation of outcomes.

Identifying appropriate source data for eligibility requirements in collaboration with enrollment teams and application owners.

Providing business-side production support by identifying and resolving eligibility issues, conducting root cause analysis, and coordinating with IT as needed. Document any trends or emerging issues and prepare reports with recommend solutions for leadership.

Conducting regular end-to-end audits of eligibility processes to ensure accuracy, compliance, and operational integrity.

Leading efforts to streamline and enhance eligibility processes, reducing manual interventions and improving automation.

Proposing, supporting and submitting IT funding requests for eligibility enhancements, including gathering supporting metrics and business justifications.

Supporting departmental goals of maintaining process controls, adhering to benefit and program policies and procedures, and ensure eligibility processes comply with CMS guidelines and other regulatory requirements.

Creating and maintaining comprehensive documentation of eligibility workflows, business rules, process flows, and system interactions.

Monitoring downstream systems to ensure accurate use of eligibility and benefit data for impacted areas such as customer service, sales, marketing, and reporting applications.

Identifying ways to streamline and enhance eligibility processes working with program owners.

Developing, implementing and overseeing monitoring processes for eligibility file exchanges, identifying operational issues and driving improvements with internal and external partners.

Point of contact for questions related to member eligibility files and applicable system data

Additionally, this position may partner and/or support various implementation and operational activities, as assigned.

Required Qualifications

5+ years of experience in business analysis, process improvement, or project management, preferably in a healthcare or insurance environment.

3+ years of Medicare experience.

Strong understanding of eligibility processes, data flows, and regulatory compliance (e.g., CMS guidelines).

Experience working with cross-functional teams, including IT, operations, and external vendors.

Proven ability to manage complex projects from concept through implementation as well as operational oversight.

Excellent analytical and problem-solving skills with a focus on root cause analysis and continuous improvement.

Strong communication skills, with the ability to translate technical concepts into business language and vice versa.

Proficiency in creating business and technical documentation, including process flows and requirements specifications.

Time and priority management skills

Self-starter who can work independently and in a matrixed environment

Candidates must be flexible to meet the changing needs of the business

Preferred Qualifications

Ability to manage multiple priorities and work effectively in a fast-paced, collaborative environment.

Detail-oriented with a commitment to accuracy and quality.

Experience in healthcare or insurance environments with eligibility systems or enrollment platforms.

Experience with data analysis tools (e.g., SQL, Excel, Power BI) or eligibility engines.

Experience developing monitoring frameworks for file exchanges or operational oversight.

Education

Bachelor’s degree in business administration, Information Systems, Healthcare Administration, or a related field.

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 08/08/2025

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