[Remote] Claims Operations, Senior Manager Meritain TPA, Remote

Note: The job is a remote job and is open to candidates in USA. Aetna Resources, LLC is hiring a Senior Manager to lead claims operations and improve service delivery. The role oversees claims teams, service quality, resources, process improvement, and initiatives that enhance member, provider, and plan sponsor satisfaction.

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

• Minimum 7 years work experience in claims operations
• 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
• Healthcare industry experience
• TPA experience in self-funding
• Dental experience
• Bachelor's degree

Benefits

• Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• An award target in the company’s equity award program.
• Medical, dental, and vision coverage, based on eligibility.
• Paid time off, based on eligibility.
• Retirement savings options, based on eligibility.
• Wellness programs, based on eligibility.
• Other resources, based on eligibility.
• Remote/hybrid work arrangement

Company Overview