Client Benefits Testing Senior Manager

Job DescriptionAs the Client Benefits Senior Manager, you will play a key role within CVS Health Benefits Operations, leading a team of Testing & Quality Assurance colleagues across Employer clients. Your span of control covers multiple sites while partnering closely with other benefit operations teams and external service providers. As the Senior Manager you will also assist in the management and follow-up of benefit operations, compliance audits, development and follow-up of corrective action plans (CAPs) and quality improvement plans and provide timely executive support for material development (e.g., presentations, critical metrics). You will have oversight of the implementation of the drug benefits, development and implementation of rigorous processes and solutions to ensure very high quality testing and release management work. You will accomplish your goals by: Leading and supporting various operations teams focused on Quality of Client changes new benefit implementations & maintenance of business Designing efficient testing methods for complex changes Developing programs that improve the knowledge levels of the benefits testing colleagues within the Employer Quality organization Leading department vision, mission, values and goals Initiating, developing and implementing process improvement plans to enhance organizational efficiency and continuous improvement via automationYour role will entail dedicated planning, effective communication, coordination and project management of select organizational initiatives, leadership team agenda development, action tracking and follow-up, and coordinating quality automation projects in support of the Employer market segment. Success in this role will be determined by your ability to meet or exceed customer service levels as well as evaluating issues coming from production corrections and handling client concerns. You will need to use your knowledge of core PBM/managed care functions with a focus on quality of benefit operations, clinical and the Rx Claim Adjudication system as well as your understanding of healthcare industry business processes including fundamental concepts regarding Regulatory requirements. You will also need to bring your deep understanding and experience with healthcare prior authorization, Formulary, Utilization Management, Drug Utilization Management, Accumulations & Copay setup, reimbursement and claims adjudication. You will hold an integral role to the continued growth of CVS Health as a leader in the PBM Marketplace.This is a work from home role. Candidates can live anywhere in the US.Required Qualifications 8 or more years of experience in managing operations/service delivery 2 or more years of experience managing complex Quality Assurance 3 years of testing experience within the RxClaim Adjudication System Willingness and Ability to travel up to 25%COVID 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 Extensive PBM system knowledge Prior knowledge with QA automation techniques and processes Excellent related benefits testing management experience and ability to define benefits test & quality strategies Excellent analytical and problem-solving skills Ability to lead Joint requirements & Design sessions that drives automation and Innovation Knowledge of operations/systems interfaces and inter-dependencies Strong decision making and creative problem-solving skills Ability to establish meaningful team goals and objectives to drive team performanceEducation Bachelors Degree is required, equivalent work experience may be consideredBusiness 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: 2025-11-15