Manager, Claim Processing

Job not on LinkedIn

🕒 May 15

🗽 New York, Maryland, +2 more states – Remote

🗽 New York – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🌴 South Carolina – Remote

💵 $66.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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 • Addresses 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 • Assists with the development of the claim processing budget by monitoring expenses and identifying cost-saving opportunities • Analyzes claim processing data and generates reports to track and evaluate key performance metrics • Collaborates with other departments to ensure effective communication and coordination in the claim processing workflow • Ensures compliance with industry regulations and company policies

🎯 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 • strong execution and delivery capabilities, including planning, implementation, and ongoing support • 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 • Certified Billing and Coding Specialist (CBCS) preferred • Candidates located on the East Coast preferred

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package based on eligibility