Claims Operations – Senior Manager Meritain TPA
| Company | CVS Health |
|---|---|
| Location | Pennsylvania, USA, Jackson Township, NJ, USA, Florida, USA, New York, NY, USA, Michigan, USA, Illinois, USA |
| Salary | $67900 – $199144 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior, Expert or higher |
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
Responsibilities
- Lead a team of Claims processors (approximately 20 employees) serving the Self-Funded segment of the Health Insurance industry
- 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.
Preferred Qualifications
- bachelor’s degree preferred/specialized training/relevant professional qualification.