Claims Associate Manager - Full Remote

Job DescriptionThe Claims Associate Manager position provides leadership of people, management of projects and initiatives through solid practices and procedures that demonstrate CVS Health's values and strategies. This position's primary responsibility is to support and gain knowledge and understanding of the Medicare Part D Claims processing rules, regulations, and requirements in addition to ensuring organizational effectiveness by providing leadership for the Client Services Departments functions. Working with the management team, internal and external partners the position contributes to the development and implementation of organizational strategies, policies, and practices.As an Associate Manager you will develop staff through supervision, training, and coaching as well as manage claims inventory, assign work, and escalate "at risk" claims to leadership and/or internal and external partners. In this role you will also serve as a point of contact for claims resolutions and questions from Clients, and internal or external partners. You will also improve the operational systems, processes, and policies in support of organizations mission, specifically, support better management reporting, information flow and management, business process and organizational planning.To be successful in this role, you need to understand and comply with Medicare Part D regulations and requirements as well as understand and utilize daily processing functions, systems, inventory, and controls. You will also need to drive compliance initiatives within the department and teams organizationally that contribute to long-term operational excellence.Additional characteristics of a successful Claims Associate Manager include: - Possess a methodical attention to detail, strong analytic thinking, and the ability to multi-task in a production based and time sensitive environment.- Be able to resolve situations with written policies and procedures - Be able to manage deadlines, expectations, and personal inventory consisting of varying complexities and urgencies, while delivering a high-quality product.- Must be able to work well within a team environment as you will be acting as a liaison to internal and external partners.- Must be an independent worker and be able to set your own priorities in a fast-paced environmentRequired Qualifications-3+ years experience leading teams, programs, and processes-Experience supervising employees in a remote workforce environment-Proficient with Microsoft Office 365 Suite including but not limited to Microsoft Teams, Excel, PowerPoint, and WordCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications-Knowledge of CMS and Caremark systems and platforms -Knowledge of Medicare Part D regulations and PBM experience-Project Management experienceEducationHigh School Diploma or GED requiredBachelor's Degree preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.

Created: 2025-10-04