Claims Operations, Senior Manager Meritain TPA, Remote
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
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 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.
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
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.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
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, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/20/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Remote
Skills:
Adjudication, Best Practices, Budgeting, Customer Escalations, Customer Experience, Customer Retention/Renewal, Customer Satisfaction, Emerging Technology, Establish Priorities, Funding, Geography, Health Information Technology, Healthcare, Incentive Programs, Industry Standards, Industry/Trade Analysis, Leadership, Operational Communications, Operational Improvement, Operations Management, Performance Metrics, Problem Solving Skills, Process Improvement, Quality Assurance, Quality Metrics, Quality Monitoring, Regulatory Compliance, Research Skills, Resolve Customer Issues, Resource Management, Safety/Work Safety, Sales Qualification, Service Delivery, Team Lead/Manager, Team Player, Time Management, Training/Teaching, Vehicle Driving
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CVS Health Corp
CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.
Company Size:
10,000 employees or more
Industry:
Biotechnology/Pharmaceuticals
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