Senior Manager, Claims Operations

CVS Health Careers

. Lead claims team responsible for timely and accurate adjudication of Self-funded, Short-term Medical, and/or Dental claim types .

Posted 11/3/2026full-timeSaint Paul • Minnesota • United StatesSenior💰 $75,400 - $182,549 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims operations management, focusing on optimizing service delivery, enhancing member satisfaction, and implementing quality assurance programs. Proficient in leveraging healthcare IT solutions and conducting industry research to drive process improvements and operational efficiency.

Highest-signal resume keywords

Claims Operations ManagementHealthcare Industry ExperienceLeadership ExperienceBusiness IntelligenceQuality Assurance Programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationProcess ImprovementOperational OptimizationHealthcare Regulations ComplianceService Delivery Management

Soft Skills

Problem SolvingDecision MakingCollaborationTeamworkGrowth Mindset

Tools & Technologies

Healthcare IT SolutionsBusiness Intelligence Tools

Industry Keywords

Self-Funded ClaimsShort-Term Medical ClaimsDental ClaimsThird Party Administrator (TPA)Service Expansion Initiatives

About the role

Key responsibilities & impact

Lead claims team responsible for timely and accurate adjudication of Self-funded, Short-term Medical, and/or Dental claim types
Oversee and optimize operational aspects of service delivery
Conduct research on industry trends, best practices, and emerging technologies
Manage staff, equipment, and budgets to optimize service delivery and resource allocation
Identify process improvement opportunities and implement efficiency strategies
Define strategies to enhance member, provider, and plan sponsor satisfaction and experience
Implement quality assurance programs to monitor service quality and compliance with healthcare regulations and industry standards
Leverage technology and healthcare IT solutions to streamline operations and improve communication and information sharing
Evaluate service expansion opportunities and implement new initiatives
Provide ongoing training and development opportunities for staff

Requirements

What you’ll need

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
Dental experience preferred
Bachelor’s degree preferred/specialized training/relevant professional qualification

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program
Equity award program