We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Senior Manager, Project Management is responsible for leading and overseeing Coordination of Benefits projects and operational initiatives that improve payment accuracy, reduce overpayments, enhance compliance, and drive process efficiency across the organization. This role manages a portfolio of complex, cross-functional projects and collaborates with stakeholders across Claims, Enrollment, Provider Services, Operations, Technology, Analytics, and Vendor Management to ensure successful delivery of strategic business objectives.
The Senior Manager is accountable for defining project scope, objectives, timelines, resource requirements, and success measures while ensuring initiatives are delivered on time, within budget, and aligned with organizational goals. This role leverages data analytics and business intelligence to identify trends, assess risks, develop solutions, and implement process improvements that enhance operational performance and the provider and member experience.
In addition to project leadership, the Senior Manager directly manages staff, providing day-to-day leadership, coaching, performance management, and professional development. Responsibilities include establishing team priorities, allocating resources, managing workload distribution, fostering collaboration, and creating a culture of accountability, innovation, and continuous improvement. The role ensures team members have the tools, training, and support necessary to achieve individual and organizational goals.
The Senior Manager serves as a key liaison between business and operational partners, communicating project status, risks, and outcomes to leadership while building strong relationships across the enterprise. Success in this role requires strong program and project management capabilities, proven people leadership experience, exceptional problem-solving skills, and the ability to lead complex initiatives that deliver measurable operational and financial results.
Financial Performance & Affordability Leadership
Own strategic affordability initiatives, savings programs, recovery opportunities, and payment accuracy improvements.
Lead financial impact assessments, forecasting activities, variance analysis, savings validation, and return-on-investment evaluations.
Develop and monitor performance metrics measuring operational effectiveness, recoveries, cost avoidance, provider impact, and financial outcomes.
Establish performance objectives, implementation priorities, operating plans, and long-term growth strategies.
Oversee multiple concurrent initiatives while ensuring alignment with organizational goals, timelines, quality requirements, and financial targets.
Required Qualifications
5+ years of leadership experience managing teams, including performance management, coaching, employee development, and workforce planning.
7+ years of experience in Payment Integrity, Healthcare Operations, claims administration, Coordination of Benefits, Medicare, Commercial Insurance, or related healthcare functions.
Demonstrated experience leading large-scale, cross-functional projects and operational transformation initiatives.
Strong knowledge of healthcare claims processing, COB regulations, Medicare Secondary Payer guidelines, NAIC rules, and related payment integrity processes.
Experience developing and implementing business process improvements that reduce operational costs, improve quality, and enhance customer satisfaction.
Experience working with healthcare technology platforms (ACAS, HRP), reporting tools, and data visualization solutions such as, Power BI, Tableau, Quickbase, or similar applications.
Preferred Qualifications
Demonstrated ability to collaborate effectively with executive leadership, operational teams, vendors, providers, and external business partners.
Experience leading organizational change management initiatives and driving adoption of new processes, workflows, and technologies.
Exceptional written and verbal communication skills, including experience presenting complex information and recommendations to senior leaders.
Knowledge of vendor management, offshore operations, workflow management, and performance metric development is strongly preferred.
Education
Bachelor's degree preferred; equivalent combination of education and relevant experience may be considered.
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
More Information
Application Details
- Organization Details4062 Aetna Resources, LLC
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