[Hiring] Claims Operations, Senior Manager @CVS Health

Role Description

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.

• 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.
• Conduct research on industry trends, best practices, and emerging technologies to identify opportunities for innovation, professional development, and improvement within service operations.
• Manage resources, including staff, equipment, and budgets, to optimize service delivery and resource allocation.
• Identify opportunities for process improvement and implement strategies to enhance the efficiency and effectiveness of service operations.
• Define strategies that aim to enhance member, provider and plan sponsor satisfaction and experience.
• Implement quality assurance programs to monitor and assess service quality and compliance with healthcare regulations and industry standards.
• Leverage technology and healthcare IT solutions to streamline service operations and enhance communication and information sharing.
• Evaluate opportunities for service expansion and implement new initiatives to meet evolving industry trends.
• Provide ongoing training and development opportunities for staff to enhance their professional skills, knowledge, and capabilities.

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.

Preferred Qualifications

• Dental experience.

Education

• Bachelor’s degree preferred/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is:

• $75,400.00 - $182,549.00

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.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.

Additional details about available benefits are provided during the application process.