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 RFI Manager within the Payment Integrity Center of Excellence (PI COE) leads the team responsible for managing and responding to official requests for information from regulatory agencies, state departments, law enforcement, and internal stakeholders. The role ensures that sensitive data and documentation are delivered accurately, on time, and in compliance with applicable requirements across multiple lines of business and jurisdictions. The manager oversees the full lifecycle of each request, from intake and triage through coordination, review, and final delivery, with a strong focus on meeting turnaround time commitments and maintaining accountability across all RFI-related activities. The manager leads a team of Senior Reporting Analysts, including staff with embedded remote notary credentials, and works closely with partners in Legal, Compliance, and Operations to maintain transparency and consistency in all responses.
Required Qualifications
• Minimum of three years managing regulatory request responses, compliance deliverables, or administrative operations supporting regulatory departments.
• Advanced knowledge of problem-solving and decision-making methods.
• 7–10 years of experience in managed care operations, compliance, regulatory affairs, or a related healthcare function.
• Strong analytical and problem-solving skills with experience in data analysis and process management.
• In-depth knowledge of regulatory standards, compliance requirements, and state-specific reporting obligations.
• Excellent communication and leadership skills.
• Experience testifying in court or formal legal proceedings, including depositions and regulatory hearings.
• Strong understanding of PHI and PII handling requirements, including HIPAA, CMS, and applicable state-specific guidelines.
• Proficiency with Microsoft Excel, SharePoint, and case management systems.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience supporting training, quality, or process improvement initiatives.
Preferred Qualifications
• Experience working with Medicaid and Medicare programs.
• Familiarity with state-specific regulatory reporting protocols and requirements
• Prior experience in a regulatory response, compliance, or administrative operations role.
• Knowledge of claims processing, provider contracting, and credentialing workflows.
• Experience in project management or process improvement.
• Accredited Health Care Fraud Investigator (AHFI) credential.
• Remote Online Notarization (RON) credential or experience.
Education
Bachelor’s degree in Criminal Justice, Healthcare Administration, Business, or a related field preferred. Equivalent professional experience and specialized training may be considered in place of a formal degree.
**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.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00This 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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