Claims Operations, Senior Manager Meritain TPA, Remote

CVS Health•Work At Home-Minnesota, MI

3d•$75,400 - $182,549•Remote

About The Position

CVS Health is seeking a Claims Operations, Senior Manager for Meritain TPA. The role provides strategic leadership and oversight to ensure exceptional customer experiences and satisfaction. The Senior Manager develops and implements service strategies, manages Claims Operations staff, monitors service quality and performance metrics, resolves escalated customer issues, and collaborates across departments to improve service for stakeholders. The role applies leadership, customer focus, and problem-solving skills to foster loyalty, retention, advocacy, and a positive service-oriented culture. The position leads a claims team responsible for timely and accurate adjudication of self-funded, Short-term Medical, and/or Dental claims. It oversees and optimizes service delivery, manages staff, equipment, and budgets, identifies and implements process improvements, and develops strategies to improve member, provider, and plan sponsor satisfaction. The Senior Manager also researches industry trends and emerging technologies, supports quality assurance and regulatory compliance, leverages healthcare IT, evaluates service expansion opportunities, and provides staff training and development.

Requirements

At least 7 years of work experience in claims operations.
Prior leadership experience managing a large team.
Adept at execution and delivery, including planning, delivering, and supporting.
Adept at business intelligence.
Adept at collaboration and teamwork.
Mastery of problem-solving and decision-making skills.
Mastery of growth mindset skills, including agility and developing yourself and others.
Bachelor’s degree preferred, or specialized training or a relevant professional qualification.

Nice To Haves

Healthcare industry experience; TPA experience in self-funding is highly preferred.
Dental experience.

Responsibilities

Lead a claims team responsible for timely and accurate adjudication of self-funded, Short-term Medical, and/or Dental claims.
Oversee and optimize service delivery to provide smooth, efficient, and coordinated healthcare services.
Research industry trends, best practices, and emerging technologies to identify opportunities for innovation, professional development, and service-operations improvement.
Manage staff, equipment, and budgets to optimize service delivery and resource allocation.
Identify process-improvement opportunities and implement strategies to enhance the efficiency and effectiveness of service operations.
Define strategies to enhance member, provider, and plan sponsor satisfaction and experience.
Implement quality assurance programs to monitor service quality and compliance with healthcare regulations and industry standards.
Use technology and healthcare IT solutions to streamline service operations and improve communication and information sharing.
Evaluate opportunities for service expansion and implement initiatives that address evolving industry trends.
Provide ongoing training and development opportunities to improve staff skills, knowledge, and capabilities.
Resolve escalated customer issues and collaborate with other departments to enhance service across stakeholder groups.