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.
This exciting role is a fast-paced healthcare provider support role, intended to foster a positive provider experience by supporting the end-to-end process of defining and supporting SOC and SOX controls through collaborating with cross-functional teams. This position will support network across all lines of business.
Understanding business operations to identify gaps and areas where new controls are required
The facilitation of business process and control documentation, which includes developing new controls and ensuring controls are designed appropriately to effectively manage risk
Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes, or other updates
Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the internal control environment, and introduce operational efficiencies
Independently collect facts, utilize strong analytical capabilities to recommend appropriate actions on complex matters, and effectively communicate status and results in a concise, timely manner.
Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made
Responsible for monthly and bi-annual controls review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule, and Rate Load Tracking Database audits
Support audits out of QNXT and PRMS systems to support Medicaid SOC and SOX controls
Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies
Must be able to effectively prioritize and review the status of assigned work to track progress and manage towards business objectives and compliance due dates.
Must exhibit leadership qualities, strong written and oral communication skills, and strategic thinking
Able to drive decisions based on data analysis
May be asked to support other projects as needed based on business need
**This position can be remote or hybrid depending on candidate location and commutable distance to a nearby office.
Required Qualifications
5+ years compliance and/or audit experience in SOC and SOX controls
5+ years of project management experience
Health insurance industry
Strong communication, critical thinking, problem resolution and interpersonal skills with proven ability to influence and collaborate with providers and internal partners at all levels.
Excellent analytical and problem-solving abilities
Ability to work independently and manage multiple priorities
Detail-oriented with a high level of integrity and professionalism
Preferred Qualifications
Advance working knowledge of business systems, applications, and tools supporting network management, contracting, and provider data systems
Experience in related business environment with exposure to provider data, processes, etc.
Education
Bachelor's degree preferred / specialized training / relevant professional qualifications
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00
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. This position also includes an award target in the company’s equity award program.
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
We anticipate the application window for this opening will close on: 12/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
