Operations Manager - Pricing Quality Assurance

and Government segments. Your role covers all delivery systems and adjudication platforms related to pharmacy claims adjudication. You will inspect the correct application of business rules, implementation processes, network structures, and pricing documents.Additional responsibilities may include assisting with output builds, assembling audit documentation, documenting process flows, and analyzing data. You will work cross-functionally with internal teams (Account Management, IT, Implementations, Benefits, CVS Health, and department leaders) and potentially external business partners (clients) for implementations and business support.

Being well-organized and deadline-focused, with the ability to make quick, efficient, and effective decisions, is crucial. Competency in MS Excel is essential for ad-hoc data analysis and reporting. Intermediate to advanced technical skills are key for utilizing department and company tools. Experience in developing standard operating procedures to improve team efficiency and turnaround times is needed. This includes navigating Sarbanes-Oxley and SAS-70 environments and managing internal and external inquiries and responses. Strong interpersonal, relationship, and communication skills are essential to resolve daily challenges and maintain client satisfaction and revenue expectations.Required Qualifications

• 5+ years of operational experience within PBM or Health Care industry.

Preferred Qualifications

• Quality assurance audit experience.

• 8+ years PBM or Health Care industry experience.

• Six Sigma belt certification.

• Knowledge of CVS Caremark network programs and procedures, including knowledge of retail pharmacy operations and claims adjudication proficiency.

• Fundamental project management knowledge and/or demonstrable experience.

• Operations experience in a volume heavy environment with strict deadlines.

• Intermediate to advanced interpersonal skills as demonstrated by successful collaboration to achieve common and shared goals across business teams.

• Strong time management skills, evidenced by experience being accountable to multiple deliverables on staggered deadlines.

• Intermediate to advanced proficiency in MS Office Suite of tools. Advanced proficiency in Excel and Access desired.

• Effective communication skills in both formal and informal written communications and speech at all levels of an organization.

Education

• Bachelor's degree or equivalent experience required.

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$60,300.00 - $132,600.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 07/26/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.