Senior Manager Client Ops Medicare AEP Workstream Lead ...

Job DescriptionAs a Senior Manager Client Ops Medicare AEP Workstream Lead on the Aetna IBU team, your primary role will be the Client Operation Workstream Lead for the Aetna Medicare AEP projects. The Client Operation Workstream Lead manages Benefits, Network, Plan Comparison Tool, Medical Integration, and others. This position develops and manages to a project plan and timeline that covers estimates, requirements, IT projects, testing, quality assurance, and effectiveness tracking. This position will own research analysis, risk management, solution validation, and issue resolution/escalation processes, requiring you to balance priorities with competing demands. This position is responsible for interfacing and communicating directly with Leaders/Senior Leaders from all different areas of the company. This position requires you to work cross-functionally across the organization. Strong written and verbal communication skills, interpersonal skills, and the ability to interface effectively with Business Users, IT project management, and team members is required. Building relationships and building trust with the various teams and Aetna Medicare team is also essential to this role. This position may require you to participate and/or lead IT projects for Aetna Medicare IT when needed. It may also require you to be responsible for certain business functions to support Client Operations or back-up other owners and/or perform QC reviews when needed.To be a candidate for this role you will possess the following:- Consultative, facilitation, and negotiation skills- Excellent verbal and written communication skills- The ability to foster interpersonal relationships (i.e. ability to quickly establish a rapport with internal/external customers) - Analytical and problem solving skills - Excellent organizational and time-management skills- Ability to find creative solutions to issues and foster that type of creativeness in the teams with whom you work- The ability to maintain focus and attention to detail while meeting project deadlines with various workstreams and deliverables- Ability to manage multiple projects with multiple priorities- Able to present complex topics either over the telephone or in person- Strong leadership skills with the ability to work in a self-directed manner- Proficient skill level with Microsoft Office Suite productsThis is a work from home role. Candidates can live anywhere in the US.Pay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 158,300Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- 8 years claims adjudication experience in PBM and Medicare D- Experience with the RxClaim Adjudication System or another adjudication system for Med D, including Med D claim analysisPreferred Qualifications- Experience with the RxClaim Adjudication System, including Medical Integration and claim analysis- 10 years claims adjudication experience in PBM and Medicare D- PBM Benefits background- Experience with follow-me-logicEducation- A Bachelor's Degree is required. Equivalent work experience may be considered.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15