Regulatory Resolution Team Manager

CVS Health • Northbrook, IL

22d

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 Regulatory Resolution Team is responsible for responding to highly sensitive and visible regulatory inquiries and complaints. This team is responsible for delivering thorough reviews, advocacy, risk analysis, and collaborative resolutions that uphold regulatory compliance and drive member satisfaction. These inquiries require elite execution, precision, and compliance with state and federal regulations, internal operations and company policies. The RRT’s work is critical to protecting the organization’s reputation and maintaining trust with members, regulatory bodies and stakeholders.

Requirements

• 5+ years of experience in health care industry or regulatory environment.
• 3+ years of experience in claim and payment policies and administration, operational, and clinical policies.
• Expert technical and written communication skills.
• Excellent problem solving and decision-making skills, including taking initiative to resolve complex issues and discern relevant information.
• Strong skills in interpreting state and federal requirements.
• Ability to prioritize work in a fast-paced environment.

Nice To Haves

• Adept at execution and delivery (planning, delivering, and supporting) skills.
• Adept at business intelligence.
• Adept at problem solving and decision making skills.
• Adept at collaboration and teamwork.
• Adept at growth mindset (agility and developing yourself and others) skills.

Responsibilities

• Review and draft all responses to member and provider regulatory complaints.
• Work collaboratively across multiple internal stakeholders and experts to ensure accurate and complaint responses.
• Strategically manage complex complaints to resolution, escalating to leadership as appropriate.
• Ensure responses are consistent with internal policies, state and federal requirements.
• Ensure responses are concise, accurate and written with an eye towards the regulator recipient.
• Ensure responses are timely and complete, meeting all regulatory due dates.

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
• Number of Employees: 5,001-10,000 employees