Senior Claims Ops Leader: Drive Experience & Efficiency

CVS Health; Saint Paul (MN); On-site; USD 75,000 - 183,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Equity award program

Bonus plan

Job summary

CVS Health in Minnesota seeks an experienced senior leader to oversee Claims Operations, drive customer experiences and satisfaction, and implement service strategies across Self-funded, Short-term Medical, and Dental claims. You will manage a large team, budgets, and quality programs while aligning with regulatory standards.

The role emphasizes strategic research, technology-led improvement, and staff development to foster loyalty and efficiency in a patient‑centered health system.

Qualifications

• Minimum 7 years work experience in claims operations.
• Healthcare industry experience, TPA experience in self-funded 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.

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 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.

Skills

Leadership

Execution

Business Intelligence

Collaboration

Problem solving

Growth mindset

Education

Bachelor’s degree

Tools

Healthcare IT systems

Job description

CVS Health in Minnesota seeks an experienced senior leader to oversee Claims Operations, drive customer experiences and satisfaction, and implement service strategies across Self-funded, Short-term Medical, and Dental claims. You will manage a large team, budgets, and quality programs while aligning with regulatory standards.

The role emphasizes strategic research, technology-led improvement, and staff development to foster loyalty and efficiency in a patient‑centered health system.