Claims Operations Leader - Self-Funded Health

CVS Health; United States; Remote; USD 75,000 - 183,000; Full time

Benefits offered by this job

Medical benefits

Retirement savings options

Paid time off

Job summary

CVS Health is seeking a senior leader to oversee Claims Operations, driving timely adjudication, service delivery excellence, and a culture focused on quality and customer satisfaction. You will manage resources, budgets, and staff while researching trends to implement innovative improvements.

The role emphasizes strong leadership, collaboration across departments, and strategic problem-solving to enhance member and provider experiences in a growing healthcare environment.

Qualifications

• Minimum 7 years in claims operations within healthcare.
• Prior leadership experience managing a large team.
• Strong execution, planning and delivery skills.

Responsibilities

• Lead claims team responsible for timely and accurate adjudication of self-funded, short-term medical, and dental claim types.
• Oversee and optimize service delivery operations and resources within budget.
• Identify opportunities for process improvement and implement strategies to enhance efficiency and customer experience.
• Provide ongoing training and development for staff and promote a culture of quality and compliance.

Skills

Leadership

Operations management

Business intelligence

Collaboration

Problem solving

Growth mindset

Education

Bachelor's degree

Job description

CVS Health is seeking a senior leader to oversee Claims Operations, driving timely adjudication, service delivery excellence, and a culture focused on quality and customer satisfaction. You will manage resources, budgets, and staff while researching trends to implement innovative improvements.

The role emphasizes strong leadership, collaboration across departments, and strategic problem-solving to enhance member and provider experiences in a growing healthcare environment.