Senior Manager, Pricing – Pharmacy Appeals

Job not on LinkedIn

🕒 July 16

🌵 Arizona, Idaho, +1 more states – Remote

🌵 Arizona – Remote 🥔 Idaho – Remote 🍁 Vermont – Remote

💵 $67.9k - $182.5k / year

⏰ Full Time

🟠 Senior

💰 Pricing Analyst

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 a team colleagues and contractors in the management of pharmacy reimbursement appeals • Ensure appeals are executed under tight Turnaround Times (TATs) and with high accuracy • Develop and implement solutions to improve and automate processes • Coach the appeal team coordinators and guide other internal business units • Work with legal and compliance team to ensure state regulatory updates are operationalized • Counsel and mentor team members, providing guidance and support

🎯 Requirements

• 7 year’s experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related domains • 5+ years directly leading operations teams • 1+ years’ experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal • Ability to work under tight deadlines • Strong mathematical problem-solving skills • Prior PBM Knowledge • Familiarity with wholesaler invoices • Bachelor’s Degree or equivalent experience required.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs