Claims Operations, Senior Manager Meritain TPA, Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. A Brief Overview Provides strategic leadership and oversight to ensure exceptional customer experiences and satisfaction by developing and implementing service strategies, managing a team of Claims Operations resources, monitoring service quality and performance metrics, resolving escalated customer issues, and collaborating with other departments to enhance service across all stakeholder groups. Applies leadership skills, customer-centric mindset, and problem-solving abilities to drive customer loyalty, retention, and advocacy while promoting a positive and service-oriented culture within the organization. What you will do

• Lead a team of Claims processors (approximately 20 employees) serving the Self-Funded segment of the Health Insurance industry
• Oversee and optimize the operational aspects of service delivery to ensure the provision of smooth, efficient, and coordinated healthcare services.
• Conducts research on industry trends, best practices, and emerging technologies to identify opportunities for innovation, professional development, and improvement within service operations.
• Manages resources, including staff, equipment, and budgets, to optimize service delivery and resource allocation.
• Identifies opportunities for process improvement and implements strategies to enhance the efficiency and effectiveness of service operations.
• Defines strategies that aim to enhance member, provider and plan sponsor satisfaction and experience.
• Implements quality assurance programs to monitor and assess service quality and compliance with healthcare regulations and industry standards.
• Leverages technology and healthcare IT solutions to streamline service operations and enhance communication and information sharing.
• Evaluates opportunities for service expansion and implements new initiatives to meet evolving industry trends.
• Provides ongoing training and development opportunities for staff to enhance their professional skills, knowledge, and capabilities.

Required Qualifications

• Minimum 7 years work experience in claims operations
• Healthcare industry experience, TPA experience in self-funding highly preferred.
• Prior leadership experience managing large team
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at business intelligence
• Adept at collaboration and teamwork
• Mastery of problem solving and decision-making skills
• Mastery of growth mindset (agility and developing yourself and others) skills

Education bachelor’s degree preferred/specialized training/relevant professional qualification. Pay Range The typical pay range for this role is: $67,900.00 - $199,144.00 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. 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 07/18/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job