Senior Manager, Client Services Adjudication Systems

Job DescriptionAs a Senior Manager, Client Services - Adjudication Systems for CVS Health you will be responsible for defining Medicaid coding standards. You will coordinate Medicaid coding ensuring consistency in all deliverables. You will also be responsible for facilitating, defining, and documenting business requirements for strategic Client Benefit projects. Your projects will be geared toward operational efficiencies in the Benefit set-up automation, design and implementation as well as support of other operational needs. You will be responsible for project concept, designing coding standards, implementation and roll-out of new standards. Strong verbal and written communications to facilitate strategic projects. To be a candidate for this role you will possess the following:- Benefit coding experience- Well-developed written communication, oral communication, and presentation skills.-Experience using a business rules engine to transform data.- Advanced business management skills including: operations, forecasting, finance, accounting, resource/materials management, distribution, QA/QC, statistical analysis, and reporting. - Demonstrated skills planning, executing, and managing complex initiatives and functions. - Ability to identify processes, functions, and procedures requiring improvement, then develop and execute appropriate solutions. - Strong Leadership Competencies in the areas of Inspiring Trust, Open Communication, People Development, Strategic Focus. - Ability to attract highly skilled people, develop and build a high performance culture.- Working knowledge of the Microsoft suite of products including Word, Excel and PowerPoint.This is a work from home role and candidates can live anywhere in the US, however the ideal candidate will live near the Northbrook, IL area.Required Qualifications- 5+ years of Benefit coding experience - 5+ years of either formal leadership experience or informal leadership experience (as either a project manager or team lead) - leading a team to meet expectations.- 3 years of healthcare experienceCOVID 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- PBM Experience- Experience coding in ODM- Experience with prescription adjudication systems- Experience with Medicaid codingEducation- Bachelors Degree required. Equivalent experience will 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: 2025-09-06