Full Job Description
Position Summary
Dynamic position within the new Network Contract Validation team, responsible for ensuring accurate payment of provider contracts through Health Rules Payor (HRP) a claims processing platform. As part of the Network Contract Validation team, you will be responsible for reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent and evaluate the pricing performance of claims. Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of the company such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business Intent Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, legal/compliance, medical policy, and/or segment leaders this position will be responsible for ensuring the correct decisions were made when configuring contract and pricing features in HRP prior to contract implementation. Additionally, this role may participate with workgroups for process improvement.
Required Qualifications
- Experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor)
- Project Management
- Basic understanding of Provider Contracting
- Experience with EXCEL and working with large data files is critical.
Preferred Qualifications
- Claims processing experience is desired.
- Experience with Health Rules Payor is desired.
- Proven track record in meeting project milestones and negotiating for resources.
- Proven communication skills both written and verbal.
- Proven ability to affect change/interpersonal skills.
- Knowledge of Aetna's Commercial and Medicare products
- Strong organization skills & time management
- Able to independently resolve problems.
- Ability to handle multiple assignments accurately and efficiently
- Able to interpret data, translate it into meaningful information and draw conclusions
Education
-Bachelor's degree preferred/specialized training/relevant professional qualification
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,300.00 - $159,120.00
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.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/15/2026
