Claims Operations, Senior Manager Meritain TPA, Remote

CVS Health•New York, MI

6d•$75,400 - $182,549•Remote

About The Position

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.

Requirements

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

Nice To Haves

Dental experience

Responsibilities

Lead claims team responsible for timely and accurate adjudication of Self-funded, Short-term Medical, and/or Dental claim types
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.