Senior Manager, Payment Integrity COE

CVS Health•Hartford, CT

3d•$75,400 - $199,144

About The Position

The Senior Manager, Payment Integrity COE Rework & Escalations provides centralized program leadership for intake, tracking, coordination, reporting, and resolution of rework and escalations across the Payment Integrity Center of Excellence. The role establishes a reliable operating rhythm, creates end-to-end visibility into status and risk, and ensures owners, dependencies, decisions, and due dates are clearly documented and actively managed. This leader works across Payment Integrity, Claims, Clinical, Network, Product, Technology, Compliance, Legal, Finance, Operations, SIU, vendors, and other enterprise partners to move complex issues from intake through closure. The role turns fragmented updates into concise, decision-ready reporting, identifies recurring drivers and control gaps, and supports leaders in prioritizing corrective actions that reduce avoidable rework and improve operational stability. The position also leads, coaches, and develops assigned employees or contractors; sets expectations and priorities; and builds repeatable capabilities that improve quality, responsiveness, and stakeholder experience. A bachelor's degree or an equivalent combination of education and relevant experience is required. The stated pay range is $75,400 to $199,144, with eligibility for a CVS Health bonus, commission, or short-term incentive program and an equity award target. The position is full-time and includes a comprehensive benefits package, subject to eligibility.

Requirements

7–10 years of progressive experience in program or project management, process improvement, audit, provider reimbursement, or analytics.
Demonstrated experience coordinating complex cross-functional initiatives with multiple owners, dependencies, and competing priorities.
Strong ability to build and maintain trackers, action plans, dashboards, scorecards, executive summaries, and governance materials.
Experience using data to identify trends, explain portfolio health, surface risk, and support prioritization and decision-making.
Excellent written, verbal, facilitation, organization, and presentation skills.
Ability to establish structure in ambiguous situations, work independently, follow through on commitments, and appropriately escalate barriers.
Proven ability to influence without direct authority and build productive relationships in a matrixed organization.
Working knowledge of healthcare claims, payment integrity, reimbursement, audit, recovery, or related operational processes.
Bachelor's degree or equivalent combination of education and relevant experience.

Nice To Haves

Experience with Commercial, Medicare, Medicaid, Marketplace, or other healthcare payment models.
Experience leading rework reduction, escalation management, root-cause analysis, corrective-action, operational governance, or continuous-improvement programs.
Advanced proficiency with Microsoft Excel, PowerPoint, Word, Teams, and SharePoint; experience with Power BI, Visio, Planner, or comparable workflow and reporting tools.
Experience coordinating vendor-related issues, service-level performance, implementation risks, or cross-enterprise handoffs.
Knowledge of Lean, Six Sigma, SIPOC, RACI, ADKAR, Agile, or other structured process, change, and project-management practices.
Professional certification such as CPC, CCS, CPMA, CFE, AHFI, PMP, Lean Six Sigma, or a related credential.

Responsibilities

Own the centralized portfolio of Payment Integrity rework items and escalations, including intake, categorization, prioritization, status, aging, dependencies, risks, decisions, and closure evidence.
Maintain a consistent source of truth for active work, documenting business and action owners, target dates, status, next steps, and escalation paths.
Coordinate concurrent workstreams, follow up on commitments, remove barriers, and prevent unresolved items from becoming operational risks.
Establish criteria and working norms for intake, triage, prioritization, handoffs, escalation, closure, and post-implementation monitoring.
Lead structured working sessions to clarify issues, scope, impact, root causes, interim controls, corrective actions, and decision needs.
Connect stakeholders across functions and coordinate resolution involving multiple teams, vendors, systems, or processes.
Identify stalled work, conflicting priorities, unclear ownership, resource constraints, and dependencies; elevate decision points with options and recommendations.
Support sensitive or high-impact escalations with disciplined documentation, neutral facilitation, and timely communication.
Develop and maintain dashboards, scorecards, portfolio summaries, aging reports, risk views, and leadership updates.
Define and report measures such as intake volume, backlog, aging, cycle time, on-time actions, closure rate, recurrence, and financial or operational impact.
Synthesize updates into decision-ready reports covering progress, trends, exceptions, risks, required decisions, and accountable owners.
Document reporting definitions, data sources, status criteria, and calculation methods, and apply them consistently.
Partner with operational owners and subject matter experts to document root causes, contributing factors, failure points, and control gaps using practical process-improvement methods.
Track corrective and preventive actions through implementation, validation, and sustained closure.
Analyze rework and escalation patterns to identify recurring drivers, systemic issues, high-friction handoffs, and opportunities for standardization or automation.
Translate lessons learned into process, training, control, communication, governance, or technology recommendations.
Design and facilitate governance cadences for working teams, functional leaders, and executives, including agendas, pre-reads, decisions, actions, and follow-up.
Maintain decision logs, action registers, risk and issue logs, milestone plans, and escalation records with appropriate version control and auditability.
Develop standard templates, definitions, workflows, and job aids for the rework and escalation lifecycle.
Promote accountability through transparent reporting, timely follow-up, defined service expectations, and fact-based escalation.
Build partnerships with leaders, process owners, analysts, project teams, and external partners involved in rework prevention and escalation resolution.
Prepare executive summaries, briefing materials, talking points, and recommendations tailored to the audience and decision required.
Coordinate communication and readiness activities for process changes, including stakeholder alignment, documentation, training, and transition support.
Encourage a collaborative, no-blame approach focused on facts, accountability, sustainable fixes, and measurable outcomes.
Lead, coach, and develop assigned employees or contractors supporting portfolio tracking, analysis, reporting, or coordination.
Set expectations, prioritize work, review deliverables, and develop repeatable capabilities that improve quality, responsiveness, and stakeholder experience.
Create an inclusive environment that values transparency, disciplined execution, continuous improvement, and professional growth.