Senior Manager, Claims Operations

This is a fully remote position, open to applicants in Florida, +6 more states.

📋 Description

• Lead a claims team that ensures the prompt and precise adjudication of Self-funded, Short-term Medical, and/or Dental claims.

• Supervise and enhance the operational elements of service delivery.

• Investigate industry trends, best practices, and new technologies.

• Oversee staff, equipment, and budget management.

• Identify and implement opportunities for process improvements and efficiency strategies.

• Formulate strategies aimed at improving member, provider, and plan sponsor satisfaction and experience.

• Establish quality assurance programs to ensure service quality and adherence to regulatory standards.

• Utilize healthcare IT solutions to optimize operations and facilitate information sharing.

• Assess opportunities for service expansion and launch new initiatives.

• Provide continuous training and development opportunities for team members.

⛳️ Requirements

• At least 7 years of experience in claims operations.

• Experience in the healthcare industry is strongly preferred.

• TPA experience in self-funding is highly desirable.

• Previous leadership experience managing a large team is required.

• Proficient in execution and delivery, including planning, delivery, and support skills.

• Skilled in business intelligence.

• Excellent collaboration and teamwork abilities.

• Exceptional problem-solving and decision-making skills.

• Strong growth mindset with a focus on agility and personal development for oneself and others.

• Dental experience is preferred.

• A Bachelor's degree is preferred, along with specialized training or relevant professional qualifications.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.