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:
This position is directly responsible for the supervision of our workers' compensation claims program with a financial exposure for CVS. This involves the oversight of all workers' compensation claims in an assigned territory that are handled by insurance carriers and Third-Party Administrators (TPA). This position is directly responsible for ensuring adherence to claim handling guidelines, analyzing TPA performance and directing claims handling. In addition, this position requires the ability to field and provide solutions on a high volume of inquiries from the CVS business units and departments.

Responsibilities

• Proactively oversee and manage TPA performance through reporting, auditing, and claim reviews.
• Oversee the daily work product of multiple lost time and medical-only workers' compensation adjusters in your assigned territory, completing monthly audits and case reviews.
• Actively participate in internal claim reviews and legal roundtables.
• Ensure that reserves and settlement authorities are reviewed and granted in compliance with our internal processes.
• Review and interpret medical reports, expert reports, legal and various supporting claim documents.
• Analyze case and internal investigative materials to determine legal liability and that reserves are set for the known exposure.

Required Qualifications

• 1-3 years' experience handling Lost Time workers' compensation claims and/or equivalent experience with TPA oversight.
• Experience in Microsoft Office applications with a proven ability to learn new software programs and systems as required.

Preferred Qualifications

• Insurance designations is a plus.
• California workers' compensation claims handling experience or jurisdictional knowledge a plus.
• Ability to interact and navigate situations with both internal and external partners.
• Ability to work independently and in an environment requiring teamwork and collaboration.
• Ability to train less experienced TPA adjusters on implementation of claim best practices.
• Demonstrate excellent analytical, organizational, written, and communication skills, with the ability to generate concise claim outlines that capture and detail critical case components.
• Exhibit proven time management skills and the ability to oversee a high volume of cases effectively.

Education

• High School Diploma or Equivalent

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

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 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: 05/16/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.