Project Manager - Third Party Client Audit

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.

Position Summary

Meritain Health is ranked as one of the nation's largest Third-Party Administrators. Meritain Health is looking for someone who acts as an advocate for and supports the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical cost management, and operational efficiency.

Meritain Health's Project Manager for Third Party Client Audits will be responsible for the following:

• Manage end-to-end third-party claim audit projects from initiation through completion.
• Performs audits including, but not limited to quality management and procedural documentation, in accordance with company policies.
• Develop project timelines, milestones, and deliverables for audit engagements.
• Obtains required data from the appropriate source (financial, systems, billing, etc.).
• Collaborate effectively and professionally with internal and external partners.
• Conducts audit and analysis; provides evaluation of findings.
• Develops and delivers recommendations or findings in a report format suitable to the audience.
• Assume other duties/responsibilities as assigned.

The ideal candidate should possess the following skills:

• Excellent verbal and written communication skills.
• Attention to detail.
• Analytical and problem-solving skills.
• Superior critical thinking skills.
• Effective time management, organizational and prioritization skills.
• Quickly grasp business concepts, objectives, and strategies.

Required Qualifications

• 3+ years prior claim experience.
• Able to concisely summarize large amounts of information, data and tailor the summary to the audience.
• Collaborates effectively and professionally within internal and external partners.
• Strong written and verbal communication skills.
• Ability to multi-task and prioritize duties.
• Attention to detail.
• Strong MS Office skills.

Preferred Qualifications

• Prior Risk Management experience.
• Strong data analysis skills.
• Knowledge of self-funded health plans and Third-Party Administrators.

Education

• Bachelor's Degree or High School diploma/GED and equivalent work experience.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00

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: 08/01/2025

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