Sr. Manager, Pricing - Pharmacy Appeals

CVS Health; 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

Position Summary

The Senior Manager, Pricing will lead a team of colleagues and contractors in the management of specific functions related pharmacy reimbursement appeals including the Service Warranty process as well as supporting the Department of Insurance and Secondary Appeals operations. In this role, you will ensure the appeals are executed under tight Turnaround Times (TATs) and with high accuracy while making sure the team is appropriately staffed and organized. In addition, you will be responsible for developing and implementing solutions individually and being a lead working with partners to improve and automate processes to increase productivity and fulfill state regulatory changes. You will be leading and coaching the appeal team coordinators as well as guiding other internal business units to resolve issues quickly. The Senior Manager, Pricing is also responsible for working legal and compliance team to ensure state regulatory updates are operationalized. This role requires a thorough knowledge of claim adjudication, appeals related processes, and being a leader working with other internal business units to develop new solutions to meet the ever‑increasing number of complex appeal bill compliance requirements. The position will be responsible for quality control process to ensure compliance.

What you will do

• 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.

Required Qualifications

• 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.

Preferred Qualifications

• Excellent leadership skills.
• 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.

Education

Bachelor's Degree or equivalent experience required.

Pay Range

$67,900.00 - $182,549.00

This 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. This position also includes an award target in the company's equity award program.

Benefits

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.