Manager, Claim Processing

CVS Health•New York, MA

2d•$66,330 - $145,860•Remote

About The Position

Manages day-to-day activities of team by providing strategic leadership and overseeing the operations of the claims processing team(s). Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics, managing and developing a team of claims support individuals, implementing process improvement initiatives, and fostering collaboration with internal and external stakeholders to optimize claim processing, minimize errors, and enhance overall operational effectiveness and customer satisfaction.

Requirements

5–7 years of experience in healthcare claims and/or operations.
5–7 years of demonstrated leadership experience, including team oversight and performance management.
Demonstrates strong execution and delivery capabilities, including planning, implementation, and ongoing support.
Demonstrates strong problem‑solving and sound decision‑making capabilities in complex environments.
Proven ability to collaborate effectively across teams and build strong partnerships with diverse stakeholders.
Exhibits a growth mindset, including adaptability, continuous learning, and the ability to develop self and others.
Strong written and verbal communication skills.

Nice To Haves

Certified Billing and Coding Specialist (CBCS) preferred.
Candidates located on the East Coast preferred.

Responsibilities

Reviews claims for completeness, accuracy, and adherence to company policies and procedures, addressing any complex or escalated claims issues to provide guidance to claim processors in handling challenging cases.
Designs quality control processes to ensure the accuracy and consistency of claim processing, including critical follow-up procedures for effective final resolution.
Assists with the development of the claim processing budget by monitoring expenses, tracking budget variances, and identifying cost-saving opportunities while maintaining operational effectiveness and service quality.
Analyzes claim processing data and generates reports to track and evaluate key performance metrics, such as claim volume, turnaround time, accuracy rates, and productivity.
Collaborates with other departments, such as underwriting, legal, or customer service, to ensure effective communication and coordination in the claim processing workflow.
Encourages feedback from claim processors, gathers suggestions for process enhancements, and implements changes that improve efficiency, accuracy, and customer satisfaction.
Ensures compliance with industry regulations, company policies, and legal requirements related to claim processing and implements necessary adjustments to processes, documentation, or reporting requirements to maintain compliance.
Oversees ongoing training to ensure all team members are fully versed and compliant within their respective roles for claims handling and escalation.
Coordinates with internal and external business partners to provide leadership, functional advice, and training to staff as needed.