Manager (IC), Regulatory Resolution Team

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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.

Responsibilities include:

• 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.

In order to be successful in this role you must exhibit the following:

• 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.

Required Qualifications

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.

Preferred Qualifications

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.

Education

Bachelors degree required or equivalent years of relevant experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

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