Pricing & Appeals Strategy Lead

Hispanic Alliance for Career Enhancement; Nevada (IA); Hybrid; USD 67,900 - 182,549; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health in the United States is seeking a Senior Manager, Pricing to lead a team handling pharmacy reimbursement appeals, including service warranty and state regulatory updates. You will ensure timely, accurate processing and guide cross‑functional partners to improve and automate processes.

This role requires strong knowledge of claim adjudication, compliance, and coaching staff to meet evolving appeals requirements while driving productivity and quality control.

Qualifications

• 7 years of 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.

Responsibilities

• Leads with strategic leadership and guidance to pharmacy reimbursement appeals teams, ensuring effective strategies and operations are effectively progressed to improve performance.
• Oversees pharmacy appeals service warranty process to ensure timely processing and compliance with state regulations.
• Reviews and responds to complex inquiries related to pharmacy reimbursement appeals submitted by state regulators and pharmacies.
• Analyzes market trends, and competitive insights to generate actionable recommendations.
• Collaborates cross‑functionally with legal, finance, and account teams to align client strategies with business goals, enhance value propositions, and optimize appeals services.
• Influences stakeholders through effective communication and negotiation, leveraging operations expertise and industry knowledge to establish mutually beneficial partnerships and agreements.
• Applies experienced‑based pharmacy claims and appeals knowledge and insights to influence strategic decision‑making.
• Counsels and mentors team members, providing guidance and support to enhance their skills and professional development.

Skills

Leadership

Strategic thinking

Process improvement

Communication

Education

Bachelor's Degree or equivalent experience

Tools

Excel

MS Access

Salesforce

Pharmacy Portal

Job description

CVS Health in the United States is seeking a Senior Manager, Pricing to lead a team handling pharmacy reimbursement appeals, including service warranty and state regulatory updates. You will ensure timely, accurate processing and guide cross‑functional partners to improve and automate processes.

This role requires strong knowledge of claim adjudication, compliance, and coaching staff to meet evolving appeals requirements while driving productivity and quality control.