At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. 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. **Job Description** Responsible for researching complex tasks and solutioning encountered system issues; maintaining and managing automating adjustment programs/processes; providing support to leadership to meet business KPI’s; conducting user acceptance testing (UAT). Perform associated team lead duties to maintain and meet business performances. Manage work inventory; provide training on work tasks; mentor and be the subject matter expert (SME) to team members. + Support leadership, assist in strategic planning and overall work completion to meet established KPI’s. + Collaboratively develop training materials; perform training to new hires or internal cross-trainings. + Facilitate meetings to staff and/or other departments; provide updates/clarifications for accurate completion of work tasks. + Mentor and provide guidance on adjustments, posting of refunds, and/or recovery to team members; review and direct resources to ensure accuracy. + Distribute urgent/escalated work assignments daily to staff. + Use analytical and statistical techniques and tools to plan and perform research and analysis of processes (e.g., outcomes performance guarantees, government regulations, and customer requirements, etc.) to recommend enhancements and workable solutions. + In partnership with business owners, support the design and development of new processes. + Participate in the development and validation of master or detail UAT test plans and strategies. + Develop and design data collection capability (e.g., recovery, work inventory) + Lead working sessions to develop processes and/or resolve issues, including create enhancements and process efficiency. + Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous improvement initiatives. + Analyze and resolve complex adjustment scenarios within established time frames. + May, under supervision, develop quality assessment/measurement programs tailored to specific assignments. + Analyze customer feedback and other measures. **Required Qualifications** + Claim adjustments experience. + 2+ years medical claims processing experience. + Excellent verbal and written communication skills. + Independent decision-making skill. + Effective organizational and interpersonal skills. + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. **Preferred Qualifications** + Experience working on project teams + Experience conducting user acceptance testing (UAT) + DG claims system experience **Education** + Associate degree or equivalent experience. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $21.10 - $40.90 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. 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: 07/17/2025 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.