Manager - Medicare Complaints Operations - Technical

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.

*Applicants can live anywhere in the United States*

Position Summary

As an Individual Contributor Manager of Medicare Complaints Operations - Technical, you will play a vital role in managing business operations and system initiatives that focus on streamlining complaint processes and maintaining data integrity.

The ideal candidate will possess strong analytical skills, a deep understanding of healthcare operations, and the ability to communicate complex data insights effectively to diverse audiences. Candidates should also be skilled in creating reports, dashboards, and visualizations tailored for a senior leadership audience, presenting data-driven insights clearly and concisely. This role is pivotal in driving continuous improvement and ensuring the organization meets its operational goals. The Manager of Medicare Complaints Operations - Technical will be a key player in fostering a culture of data-driven decision-making and continuous improvement.

You will be responsible for planning and monitoring internal projects from initiation to completion, ensuring they are delivered on time, within specifications, and within budget. Designing cross-functional solutions to address business challenges will also be a key aspect of your role. You will analyze trends and patterns to identify areas for improvement, efficiency gains, and opportunities for value creation. You will use statistical techniques, data mining, and predictive modeling to uncover patterns, trends, and correlations within the data. Additionally, you will apply critical thinking and problem-solving skills to derive meaningful insights that drive business decision-making. The Manager of Medicare Complaints Operations - Technical will continually explore innovative tools and approaches to improve data analysis and drive continuous improvement within the organization.

This role is essential for ensuring that our analytics capabilities are robust, reliable, and aligned with the strategic goals of the organization. The Manager of Business Analytics will be a key player in fostering a culture of data-driven decision-making and continuous improvement.

What you will do

• Collaborate with internal and external audit teams to provide necessary data and insights, ensuring compliance with regulatory standards and internal policies.
• Monitor and enhance the quality of Operational Management Tools (OMT) by implementing best practices and conducting regular assessments to identify areas for improvement.
• Generate and distribute regular reports on OMT metrics, providing actionable insights to stakeholders to support strategic decision-making.
• Manage user access to systems and tools, ensuring that team members have the necessary permissions to perform their roles effectively.
• Develop and maintain comprehensive reporting systems for vendor performance, ensuring timely and accurate data is available for management review.
• Participates in audit data universe gathering and analyzing.
• Lead the oversight of Corrective Action Plans (CAP) and implement self-monitoring processes to ensure compliance and continuous improvement within the analytics function.
• Evaluates evolving business requirements and recommends appropriate systems alternatives and/or enhancements to current systems.
• Prepares communications and makes presentations on system enhancements and/or alternatives.
• Conducts quantitative and qualitative analyses to assess business performance and identify opportunities for improvement.
• Design, develop, and maintain Quickbase applications to streamline data collection and reporting processes, ensuring that applications meet the evolving needs of the business.
• Compiles clear and comprehensive documentation, such as business requirement documents and use cases.
• Collects and analyzes business data to identify trends, patterns, and insights.
• Develops basic process maps, flowcharts, and diagrams to document as-is and to-be processes.
• Conducts meetings, workshops, and presentations to gather feedback and validate requirements.
• Actively contributes to team meetings, brainstorming sessions, and collaborative projects, including sharing ideas, providing feedback, and contributing to the overall goals and objectives of the team.
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