Manager of Configuration & Claims Analytics

CVS Health

3d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Manager of Configuration & Claims Analytics is a core member of the Configuration and Claim Research unit within a Medicaid Managed Care organization. This role is responsible for ensuring accurate benefit, contract, and claim edit configuration within the claim processing system, supporting compliant and efficient claim processing. The Manager proactively identifies trends, analyzes configuration impacts, and recommends solutions to prevent claim errors and operational disruptions. This position also plays a critical role in investigating issues, coordinating updates, supporting state complaint responses, and driving continuous improvement across claim operations. The role collaborates closely with Configuration leadership—including the Senior Manager—as well as cross‑functional partners such as Provider Relations, Claims, Appeals & Grievances, and Compliance. This is an individual contributor role

Requirements

• 5+ years of experience with Texas Medicaid benefits, services, and regulatory requirements, with demonstrated ability to interpret and apply policy changes.
• 5+ years of experience in managed care, claims processing, or configuration within MCO operations.
• 3+ years of experience managing projects driven by Medicaid policy changes, operational improvements, or system configuration updates.
• Experience collaborating across cross-functional teams and contributing to complex operational initiatives.

Nice To Haves

• Strong analytical and problem‑solving capabilities with the ability to resolve complex claim and configuration issues.
• Ability to manage multiple priorities and work effectively in a fast‑paced environment.
• Experience supporting leadership, coordinating work across teams, and contributing to continuous improvement efforts.
• Advanced understanding of the Medicaid claim payment platforms, including configuration rules, claims workflows, and provider data structures.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager