Lead Director, Healthcare Insurance Operations Meritain TPA, Remote

Hispanic Alliance for Career Enhancement; Lansing (MI); Remote; USD 100,000 - 232,000; Full time

Job summary

An established industry player is seeking a Lead Director for Healthcare Insurance Operations to provide strategic leadership and oversight. This role focuses on enhancing member experiences through innovative service strategies and operational excellence. You will lead diverse teams, optimize service delivery, and implement best practices while fostering a culture of customer-centricity. Join a forward-thinking organization that values collaboration and problem-solving, and be part of a mission to transform healthcare for millions. This is a unique opportunity to drive change in a dynamic environment while enjoying comprehensive benefits and a competitive salary.

Benefits

401(k) with matching

Stock purchase plans

No-cost wellness programs

Flexible work schedules

Paid time off

Tuition assistance

Qualifications

• 10+ years in healthcare insurance operations focusing on member experience.
• Proven leadership in managing teams within complex organizations.
• Experience with KPIs and data-driven results.

Responsibilities

• Lead multiple functional areas to ensure exceptional member experiences.
• Develop strategies to optimize service operations and delivery.
• Foster a customer-centric culture emphasizing effective communication.

Skills

Healthcare Insurance Operations

Customer Service

Leadership

KPI Tracking

Problem Solving

Collaboration

Business Intelligence Tools

Innovation and Automation

Education

Bachelor's Degree

Tools

Business Intelligence Tools

Job description

Lead Director, Healthcare Insurance Operations Meritain TPA, Remote

Pay: Competitive

Employment type: Full-Time

Job Description

• Req#: R0550491

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Overview

Provides strategic leadership and oversight to ensure exceptional member experiences and satisfaction by developing and implementing service strategies, leading multiple teams and functions, monitoring service quality and performance metrics, resolving escalated customer issues, and collaborating with other departments to enhance the overall member experience. Applies leadership skills, a 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.

Responsibilities

• Leads five functional areas within Meritain, including claims adjustments, recovery, FSA administration, front-end mail, and data administration, with approximately six direct reports, offshore vendors, and a scope of about 160 employees.
• Develops strategies to optimize service operations, ensuring efficient and effective service delivery to meet customer needs and expectations.
• Implements industry best practices and proven methodologies to streamline processes and improve operational efficiency.
• Evaluates, selects, and integrates innovative technologies and systems to enhance service operations and customer support.
• Manages and allocates resources effectively to ensure timely and within-budget service delivery.
• Develops and monitors KPIs to measure service performance and ensure quality standards and customer expectations are met.
• Fosters a customer-centric culture emphasizing empathy, effective communication, and problem-solving in all interactions.
• Focuses on customer satisfaction and retention by monitoring feedback, addressing complaints, and implementing improvements.
• Collaborates with IT and data management teams, leveraging technology and analytics to optimize operations and enhance customer insights.
• Stays updated on industry trends, emerging technologies, and best practices, incorporating relevant knowledge into strategies and driving innovation.

Minimum Requirements

• Minimum 10 years of experience in healthcare insurance operations and/or customer service with a focus on member experience.
• Proven leadership experience managing teams in complex matrix organizations.
• Experience working with outsource vendors is a plus.
• Ability to inspire, develop, and guide teams toward achieving goals.
• Experience tracking KPIs and using data to drive results.
• Innovative thinker with a focus on automation, efficiencies, and best practices.
• Strong planning, delivery, and support skills.
• Proficiency in business intelligence tools.
• Excellent collaboration and teamwork skills.
• Strong problem-solving and decision-making abilities.
• Growth mindset with agility and a focus on development.

Education

Bachelor's degree preferred; relevant training or professional qualifications are a plus.

Pay Range

The typical pay range for this role is $100,000.00 - $231,540.00. Actual salary will depend on experience, education, location, and other factors. The role is eligible for bonuses, commissions, or incentives, and may include equity awards.

Benefits

We offer comprehensive benefits, including:

• Affordable medical plans, 401(k) with matching, and stock purchase plans.
• No-cost wellness programs, counseling, and financial coaching.
• Flexible work schedules, paid time off, family leave, dependent care resources, tuition assistance, retiree medical, and more.

For more info, visit https://jobs.cvshealth.com/us/en/benefits

Application deadline: 05/24/2025

Qualified applicants with arrest or conviction records will be considered in accordance with laws.

About CVS Health

We help people on their path to better health through our health services, plans, and community pharmacists, pioneering a comprehensive approach to total health — making care more affordable, accessible, and seamless.