Manager - Provider Network Relations, CVS Health

CVS Health

Location:
United States, Remote

Category:
IT - Administration

Contract Type:
Employment contract

Salary:

54300.00 - 159120.00 USD / Year

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Job Description:

This position is fully dedicated to GLOBAL VIP CLIENT. The ideal candidate will assist the Senior Network Manager in managing competitive and complex contractual relationships with TPAs and business partners in Africa. This role supports the international network, medical cost management, and overall claim/customer service experience. The candidate will provide concierge-level service to GLOBAL VIP CLIENT members by ensuring timely network access and proactive management of network relationships for seamless direct settlement access.

Job Responsibility:

Assist Senior Network Manager in managing competitive and complex contractual relationships with TPAs and business partners in Africa
Support international network, medical cost management, and overall claim/customer service experience
Provide concierge-level service to GLOBAL VIP CLIENT members
Ensure timely network access and proactive management of network relationships for seamless direct settlement access
Assist with day-to-day network operations
Act as a liaison between external vendors and internal team members
Assist in setting up 3-5 direct TPAs setup for GLOBAL VIP CLIENT
Manage assigned TPAs via managing day to day operational issues
Primary responsible for driving GLOBAL VIP CLIENT nominations and work with TPA to add those providers In-Network
Manage network contracting with assigned TPA(s) including addition & suspension of provider
Assist with Third Party Risk Governance process for assigned TPA(s)
Oversee, audit, and process primary TPA invoices
Manage escalated Issues – GOP, Proof of Payment, Provider suspension, Immediate client Issue resolution
Ensure service level adherence (GOP TAT, eligibility processing, claim TAT, reconciliation TAT, fee invoicing etc)
Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems
Ensure TPA guides, country guides and other internal materials are timely updated
Serve as a subject matter expert to assist the internal GLOBAL VIP CLIENT account management team

Requirements:

2+ years of International Network Management/Operations – service management experience
2+ years of International Vendor management experience
2+ years of Operations Management (Claim, Customer Service)
Must possess a successful track record to oversee and manage multiple operational and provider issues and work towards swift resolution
Strong project management skills
Excellent written and verbal communication skills
Ability to leverage technology to achieve quality and cost efficiencies
Prior client facing experience
International travel required – up to 25%
Benefits Management/Interacting with Medical Professionals
Bachelor's degree or equivalent experience

Nice to have:

Additional spoken languages are preferred
Leadership/Fostering a Global Perspective
Health Insurance understanding / business negotiations
Service/Demonstrating Service Discipline

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 10, 2025

Expiration:
September 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Manager - Provider Network Relations