CVS Health
Manager, Business Consultant
$60K–$133K
PA - Work from home +15 · Remote · Manager · Full-time · Posted Oct 2, 2026
- Location
- PA - Work from home
CT - Hartford
Work At Home-Georgia
Work At Home-West Virginia
Work At Home-Massachusetts
Work At Home-Maryland
Work At Home-South Carolina
Work At Home-Maine
Work At Home-New York
Work At Home-Virginia
Work At Home-North Carolina
Work At Home-Florida
Work At Home-New Jersey
Work At Home-New Hampshire
Work At Home-Rhode Island
Work At Home-Delaware - Experience
- 5+ years in healthcare claims operations; at least 2 years in secure data transmission; 3+ years in data management; 3+ years of leadership experience.
- Education
- Bachelor's degree preferred or a combination of professional work experience and education.
About the job
Leads state encounter and claims data submissions for DSNP, ensuring accurate, complete, timely, and compliant reporting across multiple states.
What you'll do
- Manage end-to-end encounter submissions, including 837 file transmission, state response files, reconciliation, and error resolution.
- Maintain state-specific requirements and submission processes; monitor regulatory changes and lead compliance updates.
- Partner with technical teams, vendors, and cross-functional stakeholders to improve data quality, reporting, and submission performance.
What they ask for
- 5+ years in healthcare claims operations, including medical claims processing and/or Medicare and Medicaid lines of business.
- At least 2 years overseeing secure data transmission using SFTP and other file transfer technologies.
- 3+ years in data management, including validation, reconciliation, reporting, and issue resolution.
- 3+ years of leadership managing workflows and supporting teams in healthcare operations.
Nice to have
- 2+ years working with states on DSNP encounter submissions; 2+ years working with Florida on encounter submissions.
- 2+ years of vendor management; East Coast candidates are strongly preferred.
Pay
$60,300.00 - $132,600.00 USD (base salary)
Tools
837, SFTP
Model-written summary · the original posting is authoritative