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Position Summary The Senior Manager, Payment Integrity COE Rework & Escalations provides centralized program leadership for the intake, tracking, coordination, reporting, and resolution of rework and escalations across the Payment Integrity Center of Excellence. The role establishes a reliable operating rhythm, creates end-to-end visibility to status and risk, and ensures that owners, dependencies, decisions, and due dates are clearly documented and actively managed. This leader works across Payment Integrity, Claims, Clinical, Network, Product, Technology, Compliance, Legal, Finance, Operations, SIU, vendors, and other enterprise partners to move complex issues from intake through closure. The role converts fragmented updates into concise, decision-ready reporting, identifies recurring drivers and control gaps, and supports leaders in prioritizing corrective actions that reduce avoidable rework and improve operational stability.
Primary Responsibilities:
Rework & Escalation Portfolio Management Own the centralized portfolio of Payment Integrity rework items and escalations, including intake, categorization, prioritization, status management, aging, dependencies, risks, decisions, and closure evidence. Maintain a consistent source of truth for active work, ensuring each item has a defined business owner, accountable action owner, target date, current status, next step, and escalation path. Coordinate multiple concurrent workstreams and follow up on commitments to sustain momentum, remove barriers, and prevent unresolved items from becoming operational risks. Establish criteria and working norms for intake, triage, prioritization, handoffs, escalation, closure, and post-implementation monitoring. Cross-Functional Coordination & Issue Resolution Lead structured working sessions with business and technical partners to clarify the issue, scope, impact, root cause, interim controls, corrective actions, and decision needs. Connect the appropriate stakeholders across functional boundaries and coordinate activities when resolution requires multiple teams, vendors, systems, or processes. Identify stalled work, conflicting priorities, unclear ownership, resource constraints, and unresolved dependencies; elevate decision points with clear options and recommendations. Support sensitive or high-impact escalations with disciplined documentation, neutral facilitation, and timely communication. Reporting, Metrics & Executive Visibility Develop and maintain recurring dashboards, scorecards, portfolio summaries, aging reports, risk views, and leadership updates for rework and escalation activity. Define meaningful measures for intake volume, backlog, aging, cycle time, on-time actions, closure rate, recurrence, financial or operational impact, and other agreed performance indicators. Synthesize detailed updates into concise, decision-ready reporting that highlights progress, emerging trends, exceptions, risks, required decisions, and accountable owners. Ensure reporting definitions, data sources, status criteria, and calculation methods are documented and applied consistently. Root Cause, Corrective Action & Rework Reduction Partner with operational owners and subject matter experts to document root causes, contributing factors, failure points, and control gaps using practical process-improvement methods. Track corrective and preventive actions through implementation, validation, and sustained closure rather than administrative completion alone. Analyze patterns across rework and escalation activity to identify repeat drivers, systemic issues, high-friction handoffs, and opportunities for standardization or automation. Translate lessons learned into process, training, control, communication, governance, or technology recommendations. Governance & Operating Rhythm Design and facilitate a tiered governance cadence for working teams, functional leaders, and executive stakeholders, with clear agendas, pre-reads, decisions, actions, and follow-up. Maintain decision logs, action registers, risk and issue logs, milestone plans, and escalation records with appropriate version control and auditability. Develop standard templates, definitions, workflows, and job aids that improve consistency across the PI COE rework and escalation lifecycle. Promote accountability through transparent reporting, timely follow-up, defined service expectations, and fact-based escalation.
Stakeholder Communication & Change Enablement Build trusted partnerships with leaders, process owners, analysts, project teams, and external partners involved in rework prevention and escalation resolution. Prepare executive summaries, briefing materials, talking points, and recommendations tailored to the audience and decision required. Coordinate communication and readiness activities for process changes resulting from corrective actions, including stakeholder alignment, documentation, training, and transition support. Encourage a collaborative, no-blame approach that focuses on facts, accountability, sustainable fixes, and measurable outcomes. Team Leadership & Capability Building Lead, coach, and develop assigned employees or contractors supporting portfolio tracking, analysis, reporting, or coordination. Set clear expectations, prioritize work, review deliverables, and build repeatable capabilities that improve quality, responsiveness, and stakeholder experience. Create an inclusive environment that values transparency, disciplined execution, continuous improvement, and professional growth. Key Deliverables Centralized rework and escalation tracker with clear ownership, milestones, aging, risk, impact, and closure evidence. Recurring operational and executive-level portfolio reporting, including trends, exceptions, decisions, and recommended actions. Governance calendar and meeting artifacts, including agendas, pre-reads, action logs, decision logs, and follow-up summaries. Root-cause and corrective-action documentation for priority items, with validation of implemented solutions. Standard intake, triage, prioritization, escalation, reporting, and closure practices for the PI COE. Leadership-ready summaries of portfolio health, resource or dependency constraints, and opportunities to reduce recurring rework.
Required Qualifications 7-10 years of progressive experience in program, project management, process improvement, audit, provider reimbursement, analytics. Demonstrated experience coordinating complex, cross-functional initiatives with multiple owners, dependencies, and competing priorities. Strong ability to build and maintain trackers, action plans, dashboards, scorecards, executive summaries, and governance materials. Experience using data to identify trends, explain portfolio health, surface risk, and support prioritization and decision making. Excellent written, verbal, facilitation, organization, and presentation skills. Ability to establish structure in ambiguous situations, work independently, follow through on commitments, and appropriately escalate barriers. Proven ability to influence without direct authority and build productive relationships in a matrixed organization. Working knowledge of healthcare claims, payment integrity, reimbursement, audit, recovery, or related operational processes.
Preferred Qualifications Experience with Commercial, Medicare, Medicaid, Marketplace, or other healthcare payment models. Experience leading rework reduction, escalation management, root-cause analysis, corrective-action, operational governance, or continuous-improvement programs. Advanced proficiency with Microsoft Excel, PowerPoint, Word, Teams, and SharePoint; experience with Power BI, Visio, Planner, or comparable workflow and reporting tools. Experience coordinating vendor-related issues, service-level performance, implementation risks, or cross-enterprise handoffs. Knowledge of Lean, Six Sigma, SIPOC, RACI, ADKAR, Agile, or other structured process, change, and project-management practices. Professional certification such as CPC, CCS, CPMA, CFE, AHFI, PMP, Lean Six Sigma, or a related credential.
Education Bachelor's degree or equivalent combination of education and relevant experience.
Pay Range
The typical pay range for this role is:
$75,400.00 - $199,144.00 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. This position also includes an award target in the company’s equity award program.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 11/11/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
