Senior Manager, Payer Insights and Analytics

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

CVS Health is on a mission to transform healthcare.  With a shared purpose to help people on their path to better health, we are finding new ways to care for our communities, leveraging our brick-and-mortar footprint of 10,000 stores.  At the heart of this strategy are the 180,000+ store colleagues who build unmatched human connections with our customers every day.  As we seek to simplify a complex healthcare system for the patients we serve, while delivering disruptive innovation at a rapid pace, thoughtful communications that engage, inspire, and activate our colleagues across multiple channels are increasingly essential. 

The Senior Manager, Payer Insights is the foremost authority on Retail adjudication business intelligence and is relied upon to establish strategies to improve business performance by analyzing pharmacy claims data, identifying dispensing patterns, and evaluating payer reimbursement rates.  As the proprietor of NCPDP adjudication data, the Senior Manager’s focus is to serve the analytical/business intelligence needs of various enterprise stakeholders and leverage those capabilities to identify opportunities for billing simplification as well as margin saving insights specific to third party payer adjudication to optimize payer reimbursement.  Insights derived will drive informed business decisions and solution development related to the adjudication of pharmacy claims.   In addition, the role is responsible for providing objective and professional guidance to drive strategic recommendations that will incrementally improve business outcomes. The Senior Manager will work closely with a cross-functional team charged with identifying and generating significant value tied to workflow efficiency, margin improvement, and new business growth.  This will entail supporting various value-driving initiatives, as well as leading the design, implementation, and post-delivery monitoring of select adjudication and margin-related projects.     

The ideal candidate will possess outstanding analytical and problem-solving skills, and have experience presenting to Senior Leaders with poise and credibility.  They will have demonstrated success conducting complex quantitative analysis and building models using advanced analytical tools and platforms, and have the ability to communicate effectively and succinctly, both verbally and in content creation (e.g. Microsoft PowerPoint).  This Senior Manager will have experience managing and prioritizing multiple assignments while meeting deadlines, the ability to develop effective cross-team working relationships, a strong understanding of Payers, drugs, and the Retail pharmacy financial landscape, and capacity to work independently and adapt to evolving work priorities.  Equally important, this candidate will need to be a creative, out-of-the-box thinker who is intellectually curious with a demonstrated interest in learning, while maintaining an open and honest communication style that quickly builds trust and respect.

The Senior Manager will report to the Director leading the Performance Team, and lead a team of adjudication/analytics experts.

PRIMARY DUTIES AND RESPONSIBILITIES:

Responsibilities (% Time)

• 25%: Retail pharmacy claims adjudication data stewardship, including maintenance of back-end data infrastructure, tables, and schema, oversight of analytics/business intelligence requests from enterprise stakeholders, development of self-serve on-demand insights tools/platforms, and design/implementation of new data analytics programs to support emerging business opportunities 

• 25%: Drive value opportunity identification, engaging cross-functionally with internal/external business stakeholders to surface adjudication, workflow, and margin opportunities across Payers through rigorous analysis and research, and building appropriate business cases to influence operational priorities and gain executive leader support

• 25%: Lead the design, development, implementation, and monitoring of billing solutions that deliver value for customers, colleagues, and the enterprise—working cross-functionally to prioritize, structure timelines, develop project plans, align stakeholders, and incorporate feedback in service of driving successful outcomes

• 15%: Lead the deve