[Hiring] Claims Negotiation Manager @CVS Health

Role Description

The Manager, Out-of-Network Claims Negotiation is responsible for leading the strategy, operations, and performance of the claims negotiation team supporting both No Surprises Act (NSA) claims and elective out-of-network reimbursement negotiations. This role oversees a team of negotiators focused on achieving fair, compliant, and cost-effective claim resolutions while balancing provider relations, regulatory requirements, client expectations, and member experience.

• Serve as the subject matter expert on out-of-network reimbursement methodologies, No Surprises Act (NSA) regulations, and negotiation best practices, providing strategic guidance and expertise across the organization.
• Lead daily negotiation operations while partnering closely with Product, Operations, Compliance, Analytics, and Client teams to enhance negotiation strategies, support product development, drive operational excellence, and ensure compliance with federal and state regulations.
• Monitor team performance, coach and develop negotiation talent, analyze negotiation outcomes and market trends, identify process improvement opportunities, and help shape the ongoing evolution of negotiation products and services.
• Drive measurable financial savings, foster strong provider relationships and engagement, and contribute to the achievement of key business growth and organizational objectives.

Qualifications

• 5+ years of healthcare claims, reimbursement, provider contracting, network management, or negotiation experience.
• 2+ years of leadership experience managing teams and operational performance.
• Demonstrated expertise in the No Surprises Act (NSA), out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication.
• 2+ years of experience working with payers, providers, healthcare networks, or managed care organizations.
• Demonstrated ability to lead cross-functional initiatives and support product development efforts.
• Strong analytical, communication, negotiation, and problem-solving skills.
• Proficiency in interpreting claims data, performance metrics, and reimbursement trends.
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, and Outlook).

Requirements

• Experience working with Centers for Medicare & Medicaid Services (CMS) regulations, reimbursement guidelines, and healthcare compliance requirements.
• Knowledge of the No Surprises Act (NSA) and out of network reimbursement methodologies.

Education

• Bachelor's degree or equivalent combination of education and healthcare industry experience.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Pay Range

The typical pay range for this role is: $66,330.00 - $145,860.00. 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.