Description

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.

Position Summary

The Manager of Configuration & Claims Analytics is a core member of the Configuration and Claim Research unit within a Medicaid Managed Care organization. This role is responsible for ensuring accurate benefit, contract, and claim edit configuration within the claim processing system, supporting compliant and efficient claim processing.

The Manager proactively identifies trends, analyzes configuration impacts, and recommends solutions to prevent claim errors and operational disruptions. This position also plays a critical role in investigating issues, coordinating updates, supporting state complaint responses, and driving continuous improvement across claim operations.

The role collaborates closely with Configuration leadership-including the Senior Manager-as well as cross‑functional partners such as Provider Relations, Claims, Appeals & Grievances, and Compliance.

This is an individual contributor role

Required Qualifications

• 5+ years of experience with Texas Medicaid benefits, services, and regulatory requirements, with demonstrated ability to interpret and apply policy changes.
• 5+ years of experience in managed care, claims processing, or configuration within MCO operations.
• 3+ years of experience managing projects driven by Medicaid policy changes, operational improvements, or system configuration updates.
• Experience collaborating across cross-functional teams and contributing to complex operational initiatives.

Preferred Qualifications

• Strong analytical and problem‑solving capabilities with the ability to resolve complex claim and configuration issues.
• Ability to manage multiple priorities and work effectively in a fast‑paced environment.
• Experience supporting leadership, coordinating work across teams, and contributing to continuous improvement efforts.
• Advanced understanding of the Medicaid claim payment platforms, including configuration rules, claims workflows, and provider data structures.

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 - $132,600.00

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.

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: 03/06/2026

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