Claims Negotiation Manager
CVS Health•3w ago
United StatesRemote$66.3K–$145.9KFull-timeManager Level5+ yrs exp
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 Manager, Out-of-Network Claims Negotiation is responsible for leading the strategy, operations, and performance of the claims negotiation team supporting both No Surprises Act (NSA) claims and elective out-of-network reimbursement negotiations.
This role oversees a team of negotiators focused on achieving fair, compliant, and cost-effective claim resolutions while balancing provider relations, regulatory requirements, client expectations, and member experience
What You'll Do
- Serve as the subject matter expert on out-of-network reimbursement methodologies, No Surprises Act (NSA) regulations, and negotiation best practices, providing strategic guidance and expertise across the organization.
- Lead daily negotiation operations while partnering closely with Product, Operations, Compliance, Analytics
- Client teams to enhance negotiation strategies, support product development, drive operational excellence
- ensure compliance with federal and state regulations.
- Monitor team performance, coach and develop negotiation talent, analyze negotiation outcomes and market trends, identify process improvement opportunities
- help shape the ongoing evolution of negotiation products and services.
- Drive measurable financial savings, foster strong provider relationships and engagement, and contribute to the achievement of key business growth and organizational objectives.
- Required Qualifications 5+ years of healthcare claims, reimbursement, provider contracting, network management, or negotiation experience. 2+ years of leadership experience managing teams and operational performance.
- Demonstrated expertise in the No Surprises Act (NSA), out-of-network reimbursement methodologies, provider billing practices
- healthcare claims adjudication, with the ability to interpret complex regulations, evaluate claim and reimbursement disputes, guide negotiation strategies, ensure compliance
- drive favorable financial and operational outcomes. 2+ years of experience working with payers, providers, healthcare networks
- managed care organizations.
- Demonstrated ability to lead cross-functional initiatives and support product development efforts.
- Strong analytical, communication, negotiation, and problem-solving skills.
- Proficiency in interpreting claims data, performance metrics, and reimbursement trends.
- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, and Outlook).
- Preferred Qualifications Experience working with Centers for Medicare & Medicaid Services (CMS) regulations, reimbursement guidelines, and healthcare compliance requirements.
- Knowledge of the No Surprises Act (NSA) and out of network reimbursement methodologies.
- Education Bachelor's degree or equivalent combination of education and healthcare industry experience.
- Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,330.00 - $145,860.00 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 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: 11/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.