Senior Manager, Payment Integrity COE

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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

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