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
Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
- Monitors service capabilities and collaborates cross- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
- Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
- Performs credentialing support activities as needed.
- Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
- Meets with key providers periodically to ensure service levels are meeting expectations.
- Manages the development of agenda, validates materials, and facilitates external provider meetings.
- Will collaborate cross-functionally on the implementation of products, contracts or provider demographic updates
- Sought out as a subject matter expert within the team for progress, program overviews, and state-specific contractual requirements
- Responsible for onboarding new staff, facilitating on-going training
- Position will attend and interact with external/state facilitated calls, working sessions and Joint Operating Committees
Required Qualifications
Strong knowledge of business segment specific codes, products, and terminology
5+ years' experience with business segment specific policy, benefits, plan design and language
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
5+ years in external-facing customer service working with providers
Preferred Qualifications
3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation
Education
Bachelor's Degree or equivalent experience
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00
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.
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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 05/23/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
