Claims Operations, Senior Manager Meritain TPA, Remote

CVS Health; Harrisburg (Dauphin County); Remote; USD 75,000 - 183,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an experienced leader to oversee Claims Operations, driving exemplary customer experiences and service quality. You will lead a team responsible for adjudication, optimize delivery, and explore innovative IT-enabled improvements.

The role requires 7+ years in claims operations, healthcare industry experience, and strong leadership. A bachelor’s degree is preferred, with a comprehensive benefits package and bonus eligibility.

Qualifications

• Minimum 7 years work experience in claims operations.
• Healthcare industry experience, TPA in self-funding highly preferred.
• Prior leadership experience managing large team.
• Adept at execution and delivery (planning, delivering, and supporting).
• 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.

Responsibilities

• 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 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.

Skills

Leadership

Execution

Business intelligence

Collaboration

Problem solving

Growth mindset

Education

Bachelor's degree

Job description

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: 11/06/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.