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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. The Regulatory Resolution Team is responsible for responding to highly sensitive and visible regulatory inquiries and complaints. This team is responsible for delivering thorough reviews, advocacy, risk analysis, and collaborative resolutions that uphold regulatory compliance and drive member satisfaction. These inquiries require elite execution, precision, and compliance with state and federal regulations, internal operations and company policies. The RRT’s work is critical to protecting the organization’s reputation and maintaining trust with members, regulatory bodies and stakeholders.
Job Responsibility:
Manage and lead of group of colleagues responsible for pulling together responses to member and provider regulatory complaints
Oversee the scheduling, drafting, timeliness and quality of regulatory responses
Proactively monitor team case load, status of response letters and associated due dates
Interface and negotiate with state and federal regulators, as needed
Build, maintain and promote positive and effective working relationships with internal and external stakeholders
Identify opportunities to streamline processes and improve efficiencies within the RRT and key business partners. Encourage staff to embrace new processes and identify change management opportunities within the team
Hold team accountable for meeting goals, due dates and expectations, identifying areas of individual performance concerns and coaching opportunities
Requirements:
7+ years of experience in health care industry or regulatory environment
5+ years of experience in claim and payment policies and administration, operational, and clinical policies
Bachelors degree required or equivalent years of related experience
Strong skills in interpreting state and federal requirements
Ability to prioritize work in a fast-paced environment
Expert technical and written communication skills
Excellent problem solving and decision-making skills, including taking initiative to resolve complex issues and discern relevant information
Nice to have:
Staff management experience
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at business intelligence
Adept at collaboration and teamwork
Mastery of problem solving and decision making skills
Mastery of growth mindset (agility and developing yourself and others) skills
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching