Senior Network Vendor Manager, CVS Health

CVS Health

Location:
United States, Work At Home, Florida

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

Not provided

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Job Description:

Effectively manages competitive and complex contractual relationships with TPAs and/or business partners in Europe, APAC, Africa and Middle East excluding Americas region in support of international network, medical cost management and overall claim/customer service strategies.

Job Responsibility:

Manage TPA relationship with external vendors and own overall relationship with assigned TPAs in Europe, Africa, Middle East and APAC region
Oversee and manage contractual relationship with assigned TPA(s)
Manage Third Party Risk Governance process for your assigned TPA(s)
Manage ongoing Aetna compliance review process for your assigned TPA(s)
Manage monthly billing / submission of TPA invoices for timely payment
Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems
Ensure TPA guides, country guides and other internal materials are timely updated and up to date
Ensuring streamline member experience at each country level
Evaluate network options, network efficacies and optimize network utilization to increase direct billing
End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions
Effectively negotiates and manages complex, competitive contractual relationships with providers/vendors according to prescribed guidelines in support of global and regional network strategies
Expand International provider network by contracting new direct pay providers and manage overall contracting process
Act as a Subject matter expert to assist internal sales, account management and sales support team on network and TPA questions / inquiries
Support sales as a subject matter expert on external broker / client calls
Oversee and manage any operational issues and queries regarding your assigned TPA(s)
Manage day to day provider operations, either direct or through network business partners
Ensures operational efficiency for all network processes and infrastructure through proactive provider education and collaboration with Aetna International Service Operations
Executes regional-specific strategies and tactics in response to market expectations
Executes client-specific strategies and tactics for key expatriate clients
Responsible for understanding and managing medical cost issues and initiating appropriate action from the provider perspective
Key contributor to enhanced provider service solution like provider portal and other digital solution, including development and/or management of process and technical support
Initiate legal reviews as needed
ensure all required reviews completed by appropriate functional areas

Requirements:

Benefits Management/Interacting with Medical Professionals
Strong project management skills
Prior client facing experience
Managing vendor relationships
General Business/Demonstrating Business and Industry Acumen
Sales/Managing Competitive Networks

Nice to have:

Leadership/Fostering a Global Perspective
Health Insurance understanding / business negotiations
Service/Demonstrating Service Discipline

What we offer:

Affordable medical plan options
401(k) plan including matching company contributions
employee stock purchase plan
No-cost programs for wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Additional Information:

Job Posted:
June 06, 2025

Expiration:
June 21, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Network Vendor Manager