# Senior Manager, Payment Integrity COE Rework & Escalations **Company**: CVS Health **Location**: Hartford, CT **Experience**: senior **Job type**: full-time **Salary**: $75,400.00 - $199,144.00 **Category**: Operations **Industry**: Healthcare **Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Hartford/Senior-Manager--Payment-Integrity-COE_R1059957?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/senior-manager-payment-integrity-coe-rework-and-34e12f7f-681/ ## Description We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience. 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. **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** Build trusted partnerships with leaders, process owners, analysts, project teams, and external partners involved in rework prevention and escalation resolution. - Prepare executive summaries, briefing materials, talking points, and recommendations tailored to the audience and decision required. - Coordinate communication and readiness activities for process changes resulting from corrective actions, including stakeholder alignment, documentation, training, and transition support. - Encourage a collaborative, no-blame approach that focuses on facts, accountability, sustainable fixes, and measurable outcomes. **Team Leadership & Capability Building** Lead, coach, and develop assigned employees or contractors supporting portfolio tracking, analysis, reporting, or coordination. - Set clear expectations, prioritize work, review deliverables, and build repeatable capabilities that improve quality, responsiveness, and stakeholder experience. - Create an inclusive environment that values transparency, disciplined execution, continuous improvement, and professional growth. **Key Deliverables** - Centralized rework and escalation tracker with clear ownership, milestones, aging, risk, impact, and closure evidence. - Recurring operational and executive-level portfolio reporting, including trends, exceptions, decisions, and recommended actions. - Governance calendar and meeting artifacts, including agendas, pre-reads, action logs, decision logs, and follow-up summaries. - Root-cause and corrective-action documentation for priority items, with validation of implemented solutions. - Standard intake, triage, prioritization, escalation, reporting, and closure practices for the PI COE. - Leadership-ready summaries of portfolio health, resource or dependency constraints, and opportunities to reduce recurring rework. **Required Qualifications** - 7-10 years of progressive experience in program, project management, process improvement, audit, provider reimbursement, analytics. - Demonstrated experience coordinating complex, cross-functional initiatives with multiple owners, dependencies, and competing priorities. - Strong ability to build and maintain trackers, action plans, dashboards, scorecards, executive summaries, and governance materials. - Experience using data to identify trends, explain portfolio health, surface risk, and support prioritization and decision making. - Excellent written, verbal, facilitation, organization, and presentation skills. - Ability to establish structure in ambiguous situations, work independently, follow through on commitments, and appropriately escalate barriers. - Proven ability to influence without direct authority and build productive relationships in a matrixed organization. - Working knowledge of healthcare claims, payment integrity, reimbursement, audit, recovery, or related operational processes. **Preferred Qualifications** - Experience with Commercial, Medicare, Medicaid, Marketplace, or other healthcare payment models. - Experience leading rework reduction, escalation management, root-cause analysis, corrective-action, operational governance, or continuous-improvement programs. - Advanced proficiency with Microsoft Excel, PowerPoint, Word, Teams, and SharePoint; experience with Power BI, Visio, Planner, or comparable workflow and reporting tools. - Experience coordinating vendor-related issues, service-level performance, implementation risks, or cross-enterprise handoffs. - Knowledge of Lean, Six Sigma, SIPOC, RACI, ADKAR, Agile, or other structured process, change, and project-management practices. - Professional certification such as CPC, CCS, CPMA, CFE, AHFI, PMP, Lean Six Sigma, or a related credential. **Education** - Bachelor's degree or equivalent combination of education and relevant experience. **Pay Range** - $75,400.00 - $199,144.00 For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - program management - process improvement - analytics - data analysis - communication - presentation - facilitation - organization ### Nice to have - Commercial - Medicare - Medicaid - Marketplace - Lean - Six Sigma - SIPOC - RACI - ADKAR - Agile - Power BI - Visio - Planner --- Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Hartford/Senior-Manager--Payment-Integrity-COE_R1059957?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)