• Develop and manage process improvement initiatives for member and providers • Conduct, collect and analyze information from office site and/or medical record reviews • Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements • Conduct continuing education to providers on STARS, HEDIS, and HCC Coding

• Supporting the CVS Health PBM Underwriting team by completing quality audits of financial documentation outlined in the contracts of CVS Health customers. • Aggregating discrepancies, identifying trends, and reporting findings to Underwriting senior leaders. • Ensuring adherence to underwriting guidelines, regulatory requirements, and risk appetite while continuously improving performance through actionable insights and data analysis. • Leveraging data to identify trends and opportunities for continuous improvement within the quality assurance (QA) framework for underwriting practices. • Designing and maintaining data-driven KPIs and quality scorecards to monitor underwriting performance, consistency, and compliance. • Analyzing underwriting data to detect patterns of procedural errors and developing actionable solutions. • Collaborating with underwriting, data science, and audit teams to implement quality improvement initiatives. • Driving automation and reporting tools to streamline quality reviews and enhance data transparency. • Presenting quality insights, metrics, and recommendations to senior leadership in a clear, data-supported format.

• Creating comprehensive and robust documentation and requirements that align with the Software Development Life Cycle (SDLC) phases and meet the customers' specific needs • Conducting workshops and meetings to gather requirements, prioritize features, and resolve conflicts, fostering effective stakeholder collaboration • Identifying the business needs and expectations of the customer and translating them into business change drivers and effective technical solutions • Utilizing business analysis methods and techniques to establish and document functional, non-functional, and transition requirements with end-to-end traceability throughout the project life cycle • Identifying potential risks and developing a strategy to mitigate them • Reviewing, documenting, implementing, and maintaining business processes for both the internal team and customers • Auditing project processes to improve results and customer satisfaction • Contributing to sprint planning sessions by providing insights into the feasibility and effort required to implement features • Facilitating clear, ongoing communication with all parties involved in a project to ensure a shared understanding is maintained

• Collaborate with cross-function teams to gather input on product features and process improvements • Translate complex inputs into clear and actionable business and functional specs • Work with technical teams to implement and test changes • Create and maintain detailed user stories, acceptance criteria, and backlog items in tools like JIRA • Research issues raised by internal stakeholders • Build reports to monitor system performance and identify rooms for improvement • Assist with UAT testing and obtain required software release approvals • Communicate regular updates with internal and external team members • Monitor industry trends, regulatory changes, competitor updates and customer feedback