Senior Manager, Benefits & Payment Integrity Projects

CVS Health; Houston (TX); On-site; USD 68,000 - 199,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings plan

Wellness programs

Job summary

CVS Health is seeking an experienced Senior Manager, Project Management to lead and oversee Coordination of Benefits initiatives and cross‑functional programs across Claims, Enrollment, and Operations. You will define scope, timelines, and resources while driving data‑driven improvements that enhance payment accuracy and compliance.

You will manage a team, coach staff, and partner with technology, analytics, and vendor teams to deliver measurable financial and operational results, ensuring

Qualifications

• 5+ years of leadership experience managing teams, including performance management and development.
• 7+ years of experience in Payment Integrity, Healthcare Operations, claims administration, or related healthcare functions.
• Demonstrated experience leading large‑scale, cross‑functional projects and operational transformation initiatives.
• Strong knowledge of healthcare claims processing, COB regulations, Medicare Secondary Payer guidelines, NAIC rules, and related payment integrity processes.
• Experience developing and implementing business process improvements that reduce costs and improve quality.

Responsibilities

• Lead and oversee Coordination of Benefits projects and related initiatives across Claims, Enrollment, Provider Services, Operations, Technology, Analytics and Vendor Management.
• Define project scope, timelines, resources and success measures; ensure initiatives are on time and within budget.
• Manage staff and provide day‑to‑day leadership, coaching and performance development.
• Communicate project status, risks and outcomes to leadership and key stakeholders.
• Drive data analytics and BI solutions to identify trends, assess risks and implement improvements that enhance performance and the member experience.

Skills

Leadership

Payment Integrity

Cross-functional leadership

Claims processing

Process improvement

Power BI

Vendor management

Education

Bachelor's degree

Tools

ACAS

HRP

Tableau

Job description

CVS Health is seeking an experienced Senior Manager, Project Management to lead and oversee Coordination of Benefits initiatives and cross‑functional programs across Claims, Enrollment, and Operations. You will define scope, timelines, and resources while driving data‑driven improvements that enhance payment accuracy and compliance.

You will manage a team, coach staff, and partner with technology, analytics, and vendor teams to deliver measurable financial and operational results, ensuring