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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything we do.
Job 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.
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
- Conduct research on industry trends, best practices, and emerging technologies to identify opportunities for innovation, professional development, and improvement within service operations
- Manage resources, including staff, equipment, and budgets, to optimize service delivery and resource allocation
- Identify opportunities for process improvement and implement strategies to enhance the efficiency and effectiveness of service operations
- Define strategies that aim to enhance member, provider and plan sponsor satisfaction and experience
- Implement quality assurance programs to monitor and assess service quality and compliance with healthcare regulations and industry standards
- Leverage technology and healthcare IT solutions to streamline service operations and enhance communication and information sharing
- Evaluate opportunities for service expansion and implement new initiatives to meet evolving industry trends
- Provide ongoing training and development opportunities for staff to enhance their professional skills, knowledge, and capabilities
Requirements
- 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
$75,400.00 - $182,549.00
Benefits
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.