Overview
Remote
On Site
USD 54,300.00 per year
Full Time
Skills
Health Care
Cost Management
Network Operations
Auditing
Issue Resolution
Service Level
GOP
Invoices
Customer Experience
Account Management
Network
Network Administration
Service Management
Vendor Management
Operations Management
Customer Service
Swift
Project Management
Communication
Customer Facing
Benefits Management
Leadership
Health Insurance
Negotiations
Arena
Management
Finance
Coaching
Job Details
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
POSITION SUMMARY
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. Additionally, the candidate will assist with day-to-day network operations and act as a liaison between external vendors and internal team members.
*Preference is for this person to reside within the Eastern Time Zone
JOB RESPONSIBILITIES:
REQUIRED QUALIFICATIONS:
PREFERRED QUALIFICATIONS:
EDUCATION
Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Opportunity to work in a fast pace, growing and exciting international arena supporting key Aetna International clients and managing critical Aetna vendors.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
For more information, visit ;br>
We anticipate the application window for this opening will close on: 09/30/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
POSITION SUMMARY
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. Additionally, the candidate will assist with day-to-day network operations and act as a liaison between external vendors and internal team members.
*Preference is for this person to reside within the Eastern Time Zone
JOB RESPONSIBILITIES:
- Play a critical role via assisting in setting up 3 -5 direct TPAs setup for GLOBAL VIP CLIENT in next 12 months' time frame.
- Assist Sr. Network manager to manage assigned TPAs via managing day to day operational issues with TPA for GLOBAL VIP CLIENT and work on a resolution of such issues.
- Primary responsible for driving GLOBAL VIP CLIENT nominations and work with TPA to add those providers In-Network. Manage overall responsibilities of provider nomination process for GLOBAL VIP CLIENT.
- Manage network contracting with assigned TPA(s) including addition & suspension of provider.
- Assist with Third Party Risk Governance process for your assigned TPA(s).Oversee, audit, and process primary TPA invoices; review and address disputed items as necessary.
- If any, support manage contracting/maintenance of individual direct providers
- Manage escalated Issues - GOP, Proof of Payment, Provider suspension, Immediate client Issue resolution with TPA & Provider
- If a GOP is issued but the facility does not accept it, contact the TPA or Provider immediately for a swift resolution.
- Assist Network manager in ensuring 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 and up to date.
- Ensuring streamline GLOBAL VIP CLIENT experience at each country level. Work with account management and TPA to resolve ongoing operational issues.
- End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.
- Serve as a subject matter expert to assist the internal GLOBAL VIP CLIENT account management team with network and TPA questions or inquiries. Provide support to peers and colleagues working on GLOBAL VIP CLIENT business.
REQUIRED QUALIFICATIONS:
- 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
PREFERRED QUALIFICATIONS:
- Additional spoken languages are preferred
- Leadership/Fostering a Global Perspective
- Health Insurance understanding / business negotiations
- Service/Demonstrating Service Discipline
EDUCATION
Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Opportunity to work in a fast pace, growing and exciting international arena supporting key Aetna International clients and managing critical Aetna vendors.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit ;br>
We anticipate the application window for this opening will close on: 09/30/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.