Senior Claims Operations Leader: Strategy & Impact

CVS Health; Springfield (IL); Remote; USD 75,000 - 183,000; Full time

Job summary

CVS Health is seeking a senior leader to provide strategic oversight of claims operations, driving exceptional customer experiences and service quality across the organization.

The role builds and executes service strategies, leads a large claims team, and collaborates with other departments to ensure efficient, compliant health care service delivery. A strong leadership and BI background are essential for success.

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).
• Adept at business intelligence and decision-making.

Responsibilities

• Lead claims team responsible for adjudication of Self-funded, Short-term Medical, and/or Dental claim types.
• Oversee operational aspects of service delivery for smooth, coordinated healthcare services.
• Conduct research on industry trends and emerging technologies to identify opportunities for improvement.
• Manage resources including staff, equipment, and budgets to optimize delivery.
• Identify opportunities for process improvement and implement strategies to enhance efficiency.

Skills

Leadership

Execution

Business Intelligence

Collaboration

Problem Solving

Growth Mindset

Education

Bachelor's degree

Job description

CVS Health is seeking a senior leader to provide strategic oversight of claims operations, driving exceptional customer experiences and service quality across the organization.

The role builds and executes service strategies, leads a large claims team, and collaborates with other departments to ensure efficient, compliant health care service delivery. A strong leadership and BI background are essential for success.