Claims Negotiation Manager

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🔥 0 minutes ago

🏄 California, Idaho, +1 more states – Remote

🏄 California – Remote 🥔 Idaho – Remote 🍁 Vermont – Remote

💵 $66.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead the strategy, operations, and performance of the claims negotiation team supporting No Surprises Act claims and elective out-of-network reimbursement negotiations • Oversee negotiators focused on fair, compliant, and cost-effective claim resolutions • Serve as subject matter expert on out-of-network reimbursement methodologies, No Surprises Act regulations, and negotiation best practices • Provide strategic guidance across the organization • Lead daily negotiation operations in partnership with Product, Operations, Compliance, Analytics, and Client teams • Enhance negotiation strategies and support product development • Drive operational excellence and compliance with federal and state regulations • Monitor team performance and coach and develop negotiation talent • Analyze negotiation outcomes and market trends • Identify process improvement opportunities and shape negotiation products and services • Drive measurable financial savings and foster provider relationships and engagement • Contribute to business growth and organizational objectives

🎯 Requirements

• 5+ years of healthcare claims, reimbursement, provider contracting, network management, or negotiation experience • 2+ years of leadership experience managing teams and operational performance • Expertise in the No Surprises Act, out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication • Ability to interpret complex regulations and evaluate claim and reimbursement disputes • Ability to guide negotiation strategies, ensure compliance, and drive favorable financial and operational outcomes • 2+ years of experience working with payers, providers, healthcare networks, or managed care organizations • Ability to lead cross-functional initiatives and support product development efforts • Strong analytical, communication, negotiation, and problem-solving skills • Proficiency in interpreting claims data, performance metrics, and reimbursement trends • Proficiency in Microsoft Office Suite, including Excel, PowerPoint, Word, and Outlook • Bachelor's degree or equivalent combination of education and healthcare industry experience • Preferred: experience with CMS regulations, reimbursement guidelines, and healthcare compliance requirements • Preferred: knowledge of the No Surprises Act and out-of-network reimbursement methodologies

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility