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

Contribute to the Payment Integrity program by partnering with internal team members and business areas enterprise wide to identify mis-paid claim opportunities.  Understand and compile claim criteria, write Structured Query Language/GoogleSQL (SQLs) to pull claim data, perform reviews of potential opportunities, analyze claim data, identify trends, and write requirements for accurate validation of claims. 

The primary focus of the Payment Integrity program is to prevent mis-payments from occurring prior to claim payment.

Additional responsibilities to include but not limited to the following:

Query Development

- Write Structured Query Language/GoogleSQL (SQLs) to extract claim data from various sources

- Assemble data from various sources

- Use creative problem solving and critical thinking to overcome complications and inconsistencies in the data and writing the SQL

Collaboration

- Create collaborative working relationships with team members and business partners to troubleshoot, create, and refine processes and queries

- Translate claim knowledge into identifiable criteria to write accurate SQLs

Data Analysis

- Organize and manipulate large data sets to identify key components of incorrect claim payments and identify trends

- Identify relationships between data elements and how those relationships impact the task

- Recognize trends and outliers; draw insights from trends and test those insights

- Perform reviews of potential Medicaid incorrect payment opportunities

Process & Procedure

- Use documented Standard Operating Procedures (SOP) and create new SOPS as necessary for changes and additions to business processes

- Identify practical solutions to address process gaps

- Meet or exceed standard TATs

- Work independently

- Keep multiple work tasks moving at the same time

- Keep pace with a fast-moving environment where priorities may change frequently and quickly

- Participate or lead ongoing opportunities to progress the Payment Integrity program

Required Qualifications

- Must have QNXT claim system/processing knowledge

- Must be experienced in writing code (BQL) in GCP, including joining multiple tables, subqueries, and casting.

- Proven track record of meeting deadlines

- Advanced level of at data manipulation

- Excellent problem-solving skills

- Outstanding verbal and written communication

- Detail and solution oriented

- Intuitive data analysis skills

- Inductive and deductive reasoning skills

- Strong analytical and investigative skills.

- Demonstrated ability to transform raw data into actionable items

Preferred Qualifications

- Drools Rule Language (DRL) a plus

- Experience with various applications including: QuickBase, WEBI, OPT, Tableau, Crystal Reports, Excel

Education

High School Diploma or equivalent GED

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $102,000.00

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 https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 11/28/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.