Adjudication Solutions Senior Advisor

CVS Health   •  

Northbrook, IL

Industry: Biotech/Pharma


11 - 15 years

Posted 455 days ago

This job is no longer available.

Position Summary:
As the Adjudication Solutions Senior Advisor, you will act in the role of lead project facilitator for the team and across departments. You will be responsible for facilitating, defining and documenting business requirements for strategic Client Services projects. The projects you own will be geared toward new development and operational efficiencies in the areas
Benefit set-up, Claims Adjudication, and the support of other operational needs. You will also be directly responsible for working with the information services department as key sign-off for all phases of the application development. Project concept, requirement sign-off, design sign-off, User Acceptance testing, implementation, training and roll-out of new functionality will also be key functions in this position. You will accomplish this by:
- Leading Multiple Key Projects with multiple contending deadlines
- Consulting with internal partners
- Facilitating internal and external meetings and presentations to provide status updates and make decisions relative to
client benefit setup and claims processing

This role is also expected to act as a team leader. As such, you will be:
- Mentoring and training junior team members
- Seeking opportunities for strategic improvements
- Managing and Driving key initiatives

As the Adjudication Solutions Senior Advisor, your success will be driven by your ability to effectively communicate and partner with key cross-functional partners and manage your projects across the finish-line.

Your ability to juggle multiple priorities and resolve ambiguous requests will also contribute to your success. You will operate in a rapidly changing environment with tight deadlines so ability to operate autonomously and make key decisions is imperative.

The contributions you will make will position CVSHealth as a leader in the PBM marketplace and position you as a leader within CVSHealth.

Required Qualifications:

* 10+ years of experience leading projects and multi-functional teams in an automated production environment, with
advanced business management skills including: operations, forecasting, finance, accounting, resource/materials management, distribution, QA/QC, statistical analysis, and reporting
* 5+ years of PBM or related industry experience
* 5+ years of RxClaim System experience

Preferred Qualifications:
* Progressive experience culminating in a leadership role in a health care benefits services industry or a similar industry
* Business Analyst experience Quality Assurance and/or User Acceptance Testing experience Technical Writing experience
* Demonstrated skills planning, executing, and managing complex initiatives and functions
* Ability to identify processes, functions, and procedures requiring improvement, then develop and execute appropriate
* Strong Leadership Competencies in the areas of Inspiring Trust, Open Communication, People Development, Strategic Focus
* Ability to attract highly skilled people, develop and build a high performance culture
* Working knowledge of the Microsoft suite of products
* Well-developed management, written & oral communication, and presentation skills


* Bachelor’s degree in a technical or health care related field; Equivalent experience may substitute.

Job ID: 700890BR.