Senior Manager, Claims Operations

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🔥 0 minutes ago

🐊 Florida, Illinois, +5 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote

💵 $75.4k - $182.5k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Lead claims team responsible for timely and accurate adjudication of Self-funded, Short-term Medical, and/or Dental claim types • Oversee and optimize operational aspects of service delivery • Research industry trends, best practices, and emerging technologies • Manage staff, equipment, and budgets • Identify process improvement opportunities and implement efficiency strategies • Define strategies to enhance member, provider, and plan sponsor satisfaction and experience • Implement quality assurance programs for service quality and regulatory compliance • Leverage healthcare IT solutions to streamline operations and information sharing • Evaluate service expansion opportunities and implement new initiatives • Provide ongoing training and development for staff

🎯 Requirements

• Minimum 7 years work experience in claims operations • Healthcare industry experience highly preferred • 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 • Dental experience preferred • Bachelor’s degree preferred, specialized training, or relevant professional qualification

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being