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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 The Senior Software Development Engineer – Mainframe (Claims) is a senior individual contributor responsible for developing, enhancing, and supporting enterprise claims adjudication and financial processing systems on the mainframe platform. This role focuses on building and maintaining COBOI, CICS, DB2, and batch applications that support accurate claim processing, pricing, and payment outcomes. The engineer works independently on moderately complex enhancements and production issues while collaborating with product, QA, operations, and downstream system teams. The role also supports regulatory changes, system stability, and payment integrity initiatives and contributes to modernization efforts impacting claims processing.
Key Responsibilities
Claims Application Development
Design, develop, and enhance claims adjudication, pricing, and payment‑related mainframe applications Build and maintain COBOL programs supporting claim intake, edits, pricing, provider payment, and adjustments Develop and support CICS online transactions and high‑volume batch processing flows Implement business rules aligned with claims policy, benefits, reimbursement, and payment integrity logic Perform impact analysis for benefit changes, regulatory updates, and claim rule modifications
Production Support & Stability
Perform abend analysis, root cause analysis (RCA), and defect remediation Partner with Operations and Application Support teams to meet SLA, SOX, and audit requirements Support release validation, checkouts, and production cycles for claims systems Participate in scheduled on‑call rotations when required
Data & Performance Optimization
Optimize DB2 SQL for claims queries, extracts, and payment calculations Tune batch jobs and job streams to improve cycle time, batch window adherence, and CPU efficiency Identify and resolve data integrity issues impacting claim outcomes and provider payment
Integration & Modernization
Support integration of mainframe claims platforms with downstream and upstream systems (vendor feeds, pricing engines, clinical edits) Participate in modernization initiatives such as service enablement, API exposure, and hybrid cloud integrations Collaborate with architects and senior SMEs on incremental modernization without impacting claims accuracy
Collaboration & Engineering Practices
Work closely with: Claims product owners and business partners QA, UAT, and release teams Distributed application and data platform teams Contribute to: Code reviews Design discussions Technical documentation Mentor junior engineers and support consistent engineering standards Deliver work within Agile / Scrum delivery models
Required Qualifications
5–8+ years of hands‑on mainframe application development experience Strong proficiency in: COBOL CICS, DB2, VSAM JCL and enterprise batch scheduling (e.g., Control‑M, CA‑7) Demonstrated experience supporting claims adjudication or financial transaction systems Experience with mainframe tools such as ISPF, SDSF, Endevor, File‑Aid, Abend‑Aid Strong analytical and debugging skills with attention to detail Ability to work independently on complex enhancements with minimal oversight
Preferred Qualifications
Experience in healthcare claims processing (commercial, government, or provider billing) Familiarity with claims edits, pricing logic, benefits determination, and payment adjustments Exposure to payment integrity, clinical edits, or utilization review systems Experience supporting regulatory or audit‑driven changes Prior experience working in large‑scale enterprise claims environments
Education
Bachelor’s degree in Computer Science, Engineering, or related field, or equivalent professional experience
This role is no longer accepting applications. Check the related open jobs nearby, or browse the job board for current mainframe openings.