Business Consultant, Medicare Strategy

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 Summary Support Aetna's ability to achieve its financial and strategic goals through strategic leadership over medical underwriting and risk assessment for high‑cost claimants, with a focus on protecting profitability while supporting membership growth and revenue objectives. The position oversees Large Claim Support functions, including identification, evaluation, and management of high‑risk cases across a diverse book of business. Key Responsibilities Strategic Leadership & Oversight Lead and direct managers and multi‑functional clinical underwriting teams responsible for complex, high‑profile new business and renewal underwriting decisions. Oversee core Stop Loss Center of Excellence (COE) functions, including audits, tools, underwriting strategy, training, and continuous process improvement. Own reconciliation processes and provide oversight of the Cognizant support team to ensure accuracy, consistency, and operational efficiency. Anticipate and proactively address issues that materially impact financial performance, applying sound, unbiased decision‑making. Underwriting & Risk Management Oversee a broad book of business spanning all market segments and funding arrangements, including large claimant underwriting for Aetna Signature Administrators. Guide teams in the evaluation and management of high‑cost claimant risk to optimize earnings and client outcomes. Support underwriting teams in resolving complex or escalated risk assessments. People Leadership & Talent Development Lead multiple managers and professional teams to achieve Stop Loss COE goals through clear articulation of business strategy and underwriting best practices. Identify staffing needs and drive talent management activities, including hiring, performance management, succession planning, training and professional development. Serve as a coach and mentor to managers and senior underwriters. Collaboration & Influence Build and maintain strong cross‑functional partnerships with Sales, Account Management and other internal stakeholders. Represent the organization on internal work groups and external forums, acting as a subject‑matter expert and thought leader. Effectively negotiate and resolve conflicts using clear, impactful oral and written communication. Qualifications Required Bachelor's degree or equivalent work experience. 10+ years of financial underwriting experience, including deep expertise in high‑cost claimant risk. 10+ years of Stop Loss and/or medical underwriting experience. Demonstrated experience leading managers, individual contributors and larger teams. Proven leadership capability with strong cross‑functional partnership skills. Preferred Advanced knowledge of high‑cost claimant management and Stop Loss product strategy. Broad understanding of other benefit programs (medical, dental, vision, pharmacy, Medicare, voluntary benefits) and their impact on risk assessment. Education Bachelor's degree required or equivalent experience. Degree in Mathematics, Economics, Accounting or a related field strongly preferred. Pay Range The typical pay range for this role is: $100,000.00 - $231,540.00. 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. This position also includes an award target in the company’s equity award program. 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr