Senior Manager, Pricing (Pharmacy Reimbursement Appeals)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary The Senior Manager, Pricing will lead a team colleagues and contractors in the management of pharmacy reimbursement appeals. In this role, you will ensure the appeals are executed under tight Turnaround Times (TATs) and with high accuracy while making sure the team is appropriately staffed and organized. In addition, you will be responsible for developing and implementing solutions individually and being a lead working with partners to improve and automate processes to increase productivity and fulfill state regulatory changes. You will be leading and coaching the appeal team coordinators as well as guiding other internal business units to resolve issues quickly. The Senior Manager, Pricing is also responsible for working legal and compliance team to ensure state regulatory update are operationalized. This role requires a thorough knowledge of claim adjudication, internal appeal related processes, and being a leader working with other internal business units to develop new solutions to meet the ever-increasing number of complex appeal bill compliance requirements. The position will be responsible for quality control process to ensure compliance.

Leads with strategic leadership and guidance to appeals teams, ensuring effective pricing strategies and operations are effectively progressed that improve work area profitability and revenue growth. Analyzes competitive insights to generate actionable recommendations, supporting operational decisions and improving market competitiveness. Collaborates cross-functionally with legal, finance, and account teams to align pricing strategies with business goals and enhance value propositions. Influences stakeholders through effective communication and negotiation, leveraging pricing expertise and industry knowledge to establish mutually beneficial partnerships and agreements. Applies experienced-based pricing knowledge and insights to influence strategic decision-making, contributing to the development of pricing policies, initiatives, and market positioning. Counsels and mentor pricing team members, providing guidance and support to enhance their pricing skills and professional development. Delivers pricing solutions and recommendations that drive profitability and revenue optimization and contribute to the overall financial success of the organization.

7 year’s experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related domains 5+ years directly leading operations teams 1+ years’ experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic Preferred Qualifications Excellent leadership skills Proficient in Excel, MS Access, Salesforce,