Senior Claims Operations Leader | Equity & Bonus Eligible

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

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.