Description
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 SummaryThis is a Scrum Team role that will be a member of the Medicare / Medicaid Enrollment Configuration team tasked with developing purpose-built capabilities for our NextGen platform. This role is responsible for delivering analysis, requirements of oversight for various Correspondence Extracts, Data Configuration, Composition Design and Reconciliation (i.e. from request to postmark dates) for the letter and id card defined within various regulations / guidance within Plan Sponsor Services for both Medicare Group and Individual.
- Perform analysis and translate business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve moderately complex problems (multiple interfaces with other systems within a business unit) considering all impacted components from an end-to-end perspective.
- Perform data analytics using SQL / PLSQL at an intermediate level.
- Ensure end-to-end traceability of requirements throughout the project lifecycle.
- Apply functional and business expertise to execute assigned tasks and develop specific project deliverables.
- Conduct impact analysis of configuration changes on business processes and existing technology.
- Competent to work with minimal supervision in a technical capacity on most phases of the business systems analysis.
- Estimate level of effort from development through testing, and determine when meetings are required for each story or feature.
- Document Requirements based upon Scope of Work and Document Acceptance Criteria.
- Monitor development activities to ensure project timelines are met.
- Assist in triaging questions and issues by coordinating with the Product Owner, Scrum Master, and business stakeholders to ensure timely resolution across all phases.
- Contribute to the review of Test Planning and Test Execution strategies.
- Develop business workflow diagrams.
- Assist in the development of data models and interface design specifications.
- Document, track, and resolve issues related to data quality.
- Contribute to the design and mapping of data conversion strategies.
- Participate in collaborative system and data design sessions with the user community, technical architecture resources, and development resources.
- Complete project activities on time and within budget, and proactively identifies and communicates issues that may jeopardize milestones or project budget to the Project Manager / Product Owner.
- Adhere to SDLC or AGILE project management methodology by utilizing internal procedures and tools and identifying areas for methodology improvement.
- Develop Product Overviews, FAQs, Tool Glossaries, system training material, and system user documentation to support implementation activities.
- Create appropriate communication materials are documented and distributed appropriately.
- Conduct interviews, fact-finding, and independent research to design creative, progressive solutions for business problems.
- Support the Product Owner with other Scrum Team tasks (hosts / facilitates meetings, taking detailed notes, completes analysis / research).
Required Qualifications- Experience with PLSQL, SQL Server and / or Oracle, SQL Server databases (2-4 years)
- Experience with software development lifecycles, having owned: detailed analysis (data / process analytics, process improvements, process flow creation, requirements gathering, requirements traceability through the software delivery lifecycle, including post-production checkout / reviews. (2-4 years)
- Experience with extensive analytical techniques (Scenarios and Use-cases, Scope Modeling, Functional Decomposition, Interviews, Observation / Job Shadowing, Focus Groups, Acceptance and Evaluation, Sequence Diagrams, User Stories, Brainstorming, Storyboarding, Prototyping, Event Analysis, Business Rule Analysis, Requirements Workshops, Risk Analysis, Root Cause Analysis) (2-4 years)
- 2-4 years of experience as a Business Analyst or equivalent role supporting Medicare Advantage (Part C) and/or Medicare Part D operations, with direct involvement in CMS Enrollment and Disenrollment Guidance and its application to member communications such as letters and ID Cards.
- Demonstrated expertise translating CMS regulatory requirements into business and functional requirements for member‑facing communications, including:
- Enrollment confirmation and acknowledgment letters
- Disenrollment, termination, and plan change notices
- Member ID card creation, reissuance, and correction workflows
consistent with CMS model notices and appendices. - Proven ability to analyze and document CMS requirements related to:
- Required data elements and standardized content for letters and ID cards
- Timeliness and effective‑date logic tied to enrollment and disenrollment events
- Compliance with CMS model exhibits, notice language, and formatting standards.
- Working knowledge of Medicare election periods (AEP, ICEP, OEP, SEP) and the downstream impact of those election events on communication triggers, content, and ID card issuance.
- Experience collaborating with Compliance, Operations, IT, and Print/Mail vendors to ensure CMS‑compliant implementation of communication requirements.
Preferred Qualifications- Experience with Pharmacy eligibility/claim transactions
- Experience with software development lifecycles, having contributed to estimation (resource planning), capacity planning, requirement gathering, testing framework and strategy, and post implementation review. (2-4 years)
- Experience with Medicare, Medicaid (2-4 years)
- Leadership / Creating Accountability (Intermediate)
- Leadership / Developing and Executing Strategy (Foundational)
- Leadership / Driving a Culture of Compliance (Foundational)
- General Business Consulting for requirement gathering and documentation (Foundational)
- Leadership / Anticipating and Innovating (Foundational)
- Technology / Justifying the Business Case (Foundational)
- Experience with enterprise-wide and / or cross-functional large-scale initiatives with high degree of complexity.
- Demonstrated experience successfully implementing change in complex organizations.
- Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
- Experience analyzing and implementing annual CMS contract‑year updates (e.g., CY 2025-2026) affecting enrollment‑related letters and ID cards, including updates issued via HPMS memoranda and revised CMS appendices.
- Familiarity with CMS model enrollment forms, notice exhibits, and communication appendices, and converting those artifacts into traceable business requirements and acceptance criteria.
- Experience supporting audits, compliance reviews, or internal QA related to member communications governed by CMS enrollment and disenrollment policy.
We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.
Education Bachelor's degree or equivalent experience
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$60,300.00 - $159,120.00
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 peopleWe 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: 06/16/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
