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 Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. - Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. - Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. - Performs claim re-work calculations. - Follow through completion of claim overpayments, underpayments, and any other irregularities. - Process complex non-routine Provider Refunds and Returned Checks. - Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. - Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. - Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. - May provide job shadowing to lesser experience staff. - Utilize all resource materials to manage job responsibilities. Required Qualifications - 2+ years medical claim processing experience. - Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. - Effective communications, organizational, and interpersonal skills. Preferred Qualifications - DG system claims processing experience. - Associate degree preferred. Education - High School Diploma or GED. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $42.35 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: 04/17/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• Lead, mentor, and manage the helpdesk/support team to deliver high-quality service • Own and administer the Salesforce Service Cloud platform for all helpdesk operations • Manage end-to-end case lifecycle (case creation, routing, escalation, and closure) • Configure and optimize Salesforce features: • Case queues, assignment rules, escalation rules • SLAs and entitlement processes • Omni-channel routing (chat, email, phone) • Build and maintain automation using Salesforce Flows, validation rules, and workflows • Act as the primary escalation point for high-priority incidents and system issues • Monitor SLAs, KPIs, and service metrics through Salesforce dashboards and reports • Analyze trends and implement continuous improvements in support processes • Manage knowledge base, self-service portals, and chatbot (Einstein Bots) integrations • Collaborate with IT, CRM, and business teams for enhancements and integrations • Ensure data quality, governance, and compliance within Salesforce • Support release management, UAT, and change deployments

• Lead, coach, and develop a team of 3 database engineers/administrators • Oversee administration of distributed database systems (e.g., MongoDB, Cassandra, PostgreSQL, or cloud-native databases) • Partner with architecture and application teams to design scalable, resilient data solutions • Lead database-related projects including upgrades, migrations, and platform enhancements

• Design, implement, and maintain enterprise technology solutions across on-premise infrastructure, cloud, applications, security, and/or collaboration platforms. • Serve as a subject matter expert (SME) for assigned technologies, providing Tier 3/4 support and root‑cause analysis for complex issues. • Lead technical deployments, upgrades, integrations, and migrations with minimal disruption to operations. • Develop and enforce technical standards, configurations, and best practices. • Contribute to system architecture, technology roadmaps, and lifecycle planning. • Evaluate emerging technologies and provide recommendations aligned with business and security requirements. • Ensure solutions adhere to organizational, regulatory, and security standards (e.g., NIST, ISO, CUI, etc., as applicable). • Architect, implement, and manage Microsoft 365 services, including: • Exchange Online Teams (including governance, recording, retention, and eDiscovery considerations) SharePoint Online and OneDrive Entra ID / Azure AD (identity, access control, conditional access) • Microsoft Defender security suite Design and enforce Microsoft 365 governance frameworks, including: • Tenant security configuration baselines • Data classification, retention, and lifecycle policies • External sharing and guest access controls • Lead M365 migrations, tenant consolidations, hybrid integrations, and major platform upgrades. • Serve as Tier 2/3 escalation for complex Microsoft 365 incidents impacting security, availability, or compliance. • Implement security controls and configurations to protect systems and data. • Participate in vulnerability remediation, incident response, and audit readiness activities. • Support technical compliance execution for government and regulated frameworks, such as: • NIST SP 800 53 / 800 171 • FedRAMP (supporting cloud adjacent controls) • CJIS, HIPAA, or state specific cybersecurity requirements (as applicable). • Translate compliance requirements into technical controls, configurations, and operational processes. • Lead effort for: • System Security Plans (SSPs) • POA&M • Control implementation evidence • Audit and assessment readiness. • Ensure M365 and related systems support CUI protection, data residency, logging, auditability, and access control mandates. • Partner with security, legal, and compliance teams to address findings, risks, and remediation activities. • Partner with business units, vendors, and IT leadership to gather requirements and translate them into technical solutions. • Serve as a technical liaison between engineering teams and management. • Present technical concepts and recommendations to non‑technical audiences. • Create and maintain technical documentation, diagrams, runbooks, and standard operating procedures (SOPs). • Mentor junior engineers and specialists through coaching, knowledge transfer, and technical review. • Contribute to operational maturity efforts, including automation and process optimization.