claims operations manager

Devoted Health

<div>Job Description
A bit about this role:
We&rsquo;re seeking a Claims Operations Manager to join an impact-oriented team focused on improving accuracy, reducing friction, and strengthening the integrity of our end-to-end processes. The team partners closely with Operations, Product, Engineering, Compliance, and Finance to identify breakdowns, uncover patterns, and maintain strong operations across the organization. This is an individual contributor role focused on investigation, root cause analysis, and process improvement.
You will work through operational queues with rigor and curiosity, blending thoughtful analysis and pattern recognition to build durable fixes to complex problems. This role is ideal for someone who thrives in ambiguity, enjoys untangling messy challenges, and is motivated by improving systems at scale. You will have the opportunity to become the go-to point person on the team, while also helping shape how we leverage AI agents and LLM-powered tools across the department.
Your Responsibilities and Impact will include:<ul><li>
Conduct deep, end-to-end investigations into complex operational issues, identifying root causes across people, process, policy, and technology</li><li>
Work through designated queues with high attention to detail, ensuring well-supported and clearly documented determinations</li><li>
Translate individual errors or anomalies into broader themes, trends, and systemic improvement opportunities</li><li>
Partner cross-functionally (Operations, Product, Engineering, Compliance, Finance, etc.) to implement durable solutions</li><li>
Create clear documentation, decision frameworks, and feedback loops to prevent recurrence of known issues</li><li>
Use data to validate hypotheses, quantify impact, and measure improvement over time</li><li>
Explore and implement AI-driven solutions (including AI agents and LLM-supported workflows) to enhance investigation quality and automate repeatable analyses</li><li>
Serve as a trusted advisor and escalation point for ambiguous or high-impact operational issues</li></ul>
Required skills and experience:<ul><li>
Experience in operations, consulting, analytics, process improvement, or other complex problem-solving environments</li><li>
Demonstrated strength in root cause analysis and structured problem solving</li><li>
Proven ability to move from case-level detail to system-level insight</li><li>
Experience identifying process gaps and driving measurable operational improvements</li><li>
Strong analytical skills, including comfort working with data to identify trends and quantify impact</li><li>
Excellent written and verbal communication skills, with the ability to clearly explain complex findings and recommendations</li><li>
Ability to operate independently with sound judgment in ambiguous, fast-paced environments</li><li>
Strong cross-functional collaboration skills and ability to influence without direct authority</li></ul>
Desired skills and experience:<ul><li>
Experience in healthcare operations</li><li>
Experience building dashboards, tracking mechanisms, or structured issue management processes</li><li>
Curiosity and hands-on experience with AI tools, automation, or LLM-based workflows in operational settings</li></ul>
#LI-Remote 
Salary range: $73,000 - $120,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:<ul><li>
Employer sponsored health, dental and vision plan with low or no premium</li><li>
Generous paid time off</li><li>
$100 monthly mobile or internet stipend</li><li>
Stock options for all employees</li><li>
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles</li><li>
Parental leave program</li><li>
401K program</li><li>
And more....</li></ul><ul><li>Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.</li></ul>
Healthcare equality is at the center of Devoted&rsquo;s mission to treat our members like family. We are committed to a diverse and vibrant workforce.
At Devoted Health, we&rsquo;re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That&rsquo;s why we&rsquo;re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company &mdash; one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted&rsquo;s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.</div>
 <div></div><div><div><div><div><div>We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for &ldquo;start up costs&rdquo; or &ldquo;equipment&rdquo;), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.</div></div></div></div></div>

Claims Operations Manager-Payment Accuracy

Imagenet, LLC

<div>Claims Adjudication Manager

U.S.-Based Operational Leader Overseeing Philippines Claims Adjudication 
Work Setup: Remote

Reports To: SVP Operations

Direct Oversight: Philippines-based claims adjudication team (examiners, auditors, team leads)

Hours: Pacific Time Zone: Core overlap with Philippines business hours required; evening calls for client/offshore alignment 
Role Summary

Imagenet is seeking an experienced, U.S.-based Claims Adjudication Manager to provide hands-on operational leadership for a claims adjudication account, which is delivered through our wholly owned global delivery center in the Philippines. This is a player-coach role for a seasoned claims subject-matter expert (SME) who can bridge U.S. client expectations and offshore delivery &mdash; directly strengthening quality, throughput, reporting accuracy, and client-facing credibility. 
The successful candidate combines deep adjudication expertise in both hospital (facility) and professional claims with proven experience leading and developing offshore claims teams. They will serve as the senior operational point of contact for the client, set the standard for adjudication accuracy, and build the coaching, audit, and documentation infrastructure needed to deliver consistent, high-quality outcomes at scale. They will not hesitate to role up their sleeves and dive into production and quality. 
Key Responsibilities

Operational Leadership (Onshore Lead for Offshore Delivery)
<ul>
<li>Provide day-to-day operational leadership for the Philippines-based adjudication team (examiners, auditors, and team leads), working across time zones to direct priorities and remove blockers.</li>
<li>Serve as the hands-on claims SME for the campaign &mdash; personally adjudicating complex or escalated claims and modeling correct handling for the team.</li>
<li>Drive accuracy, productivity, quality, and service-level goals; translate client requirements into clear, executable operating procedures.</li>
<li>Partner with the offshore manager and team leads to strengthen communication, information flow, and consistency of execution.</li>
</ul>
Client Engagement &amp; Single Point of Contact
<ul>
<li>Act as the senior operational single point of contact (SPOC) for the client, consolidating guidance from multiple client stakeholders into one consistent set of directives for the delivery team.</li>
<li>Lead client working sessions, escalations, and operational updates with confidence and credibility; provide clear written and verbal updates on performance, quality, and improvement actions.</li>
<li>Manage frequently changing client requirements &mdash; capturing, sequencing, and operationalizing new directives without disrupting production.</li>
</ul>
Quality, Coaching &amp; Audit
<ul>
<li>Own the quality program: reduce repeat errors, identify root causes, and close coaching gaps through targeted, SME-led feedback.</li>
<li>Align coaching responsibilities with subject-matter expertise; design and lead calibration sessions between examiners and auditors.</li>
<li>Assess auditor capability and set audit-throughput targets that balance thoroughness with release timelines.</li>
</ul>
Reporting &amp; Production Validation
<ul>
<li>Oversee validation of production reporting; partner with the business analyst and client to resolve reporting discrepancies (e.g., over- or under-counting) and establish a trusted tracking methodology.</li>
<li>Use data to identify capacity, monitor service levels, and demonstrate measurable improvement to the client.</li>
</ul>
Documentation &amp; Knowledge Management
<ul>
<li>Establish and maintain a centralized documentation and knowledge-management process for client directives, reducing reliance on individual knowledge.</li>
<li>Ensure source documentation is centralized and current so that AI-assisted retrieval and other enablement tools deliver reliable answers.</li>
</ul>
Workforce &amp; Cross-Functional Collaboration
<ul>
<li>Partner with HR and recruiting to accelerate hiring, rebuild the candidate pipeline, and stabilize staffing levels.</li>
<li>Collaborate with QA, training, workforce management, infrastructure/IT (including connectivity and latency monitoring for remote staff), and client services to support execution.</li>
<li>Coordinate with consultants, business analysts, and transition partners during onboarding and ramp activities.</li></ul> 


Must-Have Qualifications
<ul>
<li>6+ years of U.S. healthcare claims adjudication experience, with hands-on expertise in BOTH hospital/facility (UB-04) and professional (CMS-1500/HCFA) claims.</li>
<li>3+ years leading claims teams (managing 30&ndash;40+ examiners/auditors, directly or through team leads), ideally including offshore or BPO/shared-services teams.</li>
<li>Demonstrated ability to serve as a client-facing operational leader &mdash; running working sessions, owning escalations, and building client trust.</li>
<li>Strong command of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.</li>
<li>Proven track record managing productivity, quality, service levels, and team performance in a metrics-driven environment.</li>
<li>Experience coaching examiners and reducing error rates through structured quality and calibration programs.</li>
<li>Excellent written and verbal communication; able to work effectively across cultures and time zones.</li>
<li>Strong analytical and problem-solving skills, including working with production and quality data.</li></ul> 


Preferred Qualifications
<ul>
<li>Experience overseeing or supporting Philippines-based or other offshore healthcare claims operations.</li>
<li>Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared-services operations.</li>
<li>Exposure to payment review, denials, appeals, or related claims functions.</li>
<li>Experience building documentation/SOP libraries and knowledge-management processes.</li>
<li>Exposure to process improvement, automation, or digital-transformation initiatives (including AI-assisted enablement tools).</li>
<li>Familiarity with claims platforms and reporting validation.</li></ul> 


Key Competencies
<ul>
<li>Hands-on claims adjudication expertise (hospital + professional)</li>
<li>Operational leadership of distributed / offshore teams</li>
<li>Client and stakeholder communication; single point of contact</li>
<li>Quality, coaching, and audit calibration</li>
<li>Analytical thinking, reporting validation, and problem-solving</li>
<li>Continuous improvement and cross-functional collaboration</li></ul> 


Company Overview

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services &mdash; including digital transformation, claims adjudication, and member and provider engagement services &mdash; acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with their members and providers. 
The company currently serves over 70 health plans, processing millions of claims and the related structured and unstructured data elements within those claims annually. Imagenet has also developed an innovative workflow technology platform, JetStream&trade;, to support traceability, governance, and automation of claims operations for its clients. 
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S., and has a wholly owned global delivery center in the Philippines.</div>

Claims Adjudication Manager

ACCREDITED INSURANCE

<div><h3 class="jobSectionHeader">Description</h3><div> 
The Claims Manager provides strategic oversight and direction for a portfolio of claims managed by program administrators and/or TPAs across multiple lines of business. This role ensures claim adjudication is consistent with policy and contract language, regulatory requirements, and company standards while driving continuous improvement in vendor performance, claims outcomes, and operational efficiency. The Claims Manager is accountable for oversight of claim portfolios handled by program administrators/TPAs and ensuring compliance with governance standards, reporting requirements and audit protocols. Additionally, the Claims Manager will drive continuous improvement in claims handling quality, referral efficiency, and oversight workflows.</div> 
<h3 class="jobSectionHeader">
Key Responsibilities</h3> 
<ul>
<li>
 Provide strategic oversight of claim handling within assigned programs, ensuring accurate coverage determinations, liability assessments, reserving, and damages evaluations.</li>
<li>Oversee program administrator/TPA claim investigations, performance, and reporting to ensure alignment with Accredited&rsquo; s standards and obligations.</li>
<li>Review claim notices and reports for accuracy and completeness; confirm timely escalation of high exposure, litigated, or disputed matters.</li>
<li>Ensure appropriate interpretation and application of contract language, with decisions grounded in governing agreements and applicable law; evaluate reinsurance contract response and loss allocation, as applicable.</li>
<li>Monitor claim activity and develop reporting for leadership on emerging risks, portfolio trends, and potential disputes.</li>
<li>Support counsel in arbitration, litigation, and dispute resolution, contributing to strategic positioning.</li>
<li>Maintain diary control and verify reserves and file updates accurately reflect company exposure.</li>
<li>Lead or contribute to special projects, policy development, and process improvements across the claims function.</li>
<li>Collaborate with leadership across Underwriting, Legal, Reinsurance, and Operations to strengthen claims governance and outcomes.</li>
<li>Provide oversight of casualty and specialty claims, including general liability, products</li>
<li> liability, commercial auto, and professional lines.</li>
<li>Ensure appropriate evaluation of liability, damages, and reserving in complex bodily injury and litigated matters.</li>
<li>Lead oversight of litigation management, aligning defense strategy with business objectives.</li>
<li>Monitor emerging casualty risks (e.g., nuclear verdicts, social inflation) and escalate portfolio concerns to leadership.</li></ul><div></div><h3 class="jobSectionHeader"> 
Skills &amp; Experience</h3> 
<ul>
<li>
Must possess casualty claims expertise, including complex liability and litigated claims.</li>
<li>Experience leading and managing external partners, including TPAs and MGAs, with a focus on vendor performance and quality outcomes.</li>
<li>Experience working in vendor-heavy adjusting environments; prior TPA and/or client service experience is preferred.</li>
<li>Strong analytical, organizational, interpersonal, and communication skills, with the ability to influence external partners and internal stakeholders, manage multiple priorities, and adapt in fast-paced, deadline-driven environments.</li>
<li>Ability to balance strategic oversight with operational execution while working independently and exercising sound judgment.</li>
<li>Familiarity with reinsurance structures, delegated authority models, and contract interpretation.</li>
<li>5&ndash;10 years of experience handling multiline commercial claims, including admitted, non-admitted, and program business.</li>
<li>Ability to work in the office (New York or Orlando highly preferred) up to three days per week.</li>
<li>Willingness to travel occasionally (approximately 2&ndash;4 trips annually).</li>
</ul><div>Education:</div><ul>
<li>Bachelor&rsquo;s degree in business, finance, or related field.</li>
<li>Professional designations (CPCU, AIC, etc.) are a plus.</li>
<li>Insurance adjuster license (or ability/willingness to obtain) required in applicable jurisdictions.</li></ul><div> 
</div><div>
The applicable base salary range for this role is $120,000 to $130,000. The base pay offered will be determined on factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives. 
 
We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings, as well as employee assistance programs. 
 
Accredited is an Equal Opportunity Employer committed to fostering an inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic.</div><div></div><h3 class="jobSectionHeader"> 
About Accredited Insurance</h3><div>
A leading program manager operating across the US, UK and Europe, Accredited is the only dedicated program partner to provide A- rated insurance capacity in each of the US, UK and Europe, writing admitted and non-admitted business in all 50 US states. 
</div><div>A.M. Best, a global credit rating agency specializing in the insurance industry affirms the Financial Strength Rating of A- (Excellent), with a Financial Size Rating of IX for Accredited Specialty Insurance Company, Accredited Surety and Casualty Company Inc. (also referred to as Accredited America) and Accredited Insurance (Europe) Limited (Malta), collectively known as Accredited. 
</div><div>Accredited America offers a broad range of insurance solutions in 50 states and the District of Columbia. The strength behind Accredited America is Accredited Surety and Casualty Company, Inc. and Accredited Specialty Insurance Company, both of which are rated A- by AM Best. 
</div><div>Accredited Insurance (Europe) Limited is a Maltese based insurer providing capacity solutions in the UK and across Europe, across a number of different product lines. Accredited Europe is A- rated by A.M. Best.</div></div>

Claims Manager, Casualty and Specialty

OneAmerica Financial Partners, Inc

<div>At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together. Come be a part of this journey with us as we champion lives!

The Supplemental Health Claims Manager is an individual contributor responsible for providing subject matter expertise to design, implement, and continuously improve supplemental health claims processes, procedures, and workflows. This role partners closely with Claims Operations, Product, Compliance, Training, and Technology teams to ensure customer-focused, compliant, and efficient claims practices. The position may also adjudicate claims and support quality initiatives as needed.

Key Responsibilities:
<ul>
<li>Process, procedure, and workflow design: Lead the development and implementation of new and revised supplemental health claims processes, standard operating procedures (SOPs), desk-level job aids, workflow diagrams, and controls to support consistent, scalable operations.</li>
<li>Technical claims subject matter expertise: Serve as the go-to expert for supplemental health products (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.) and interpret plan provisions, definitions, limitations, exclusions, riders, and administrative rules to guide accurate claims outcomes.</li>
<li>Systems design and requirements support: Partner with Technology and business stakeholders to translate operational needs into clear requirements (rules, routing, templates, decision logic, edits, and reporting), validate design, and support testing (UAT) to ensure systems enable compliant and efficient claims processing.</li>
<li>Eligibility and efficiency optimization: Identify opportunities to improve eligibility verification, evidence collection, and straight-through processing; recommend automation and controls to reduce rework, turnaround time, and preventable denials while maintaining accuracy and customer experience.</li>
<li>Training and knowledge enablement: Contribute to training program development by creating curriculum content, job aids, and scenario-based learning; deliver or support training for new hires and tenured staff on product knowledge, systems, and procedure changes.</li>
<li>Continuous improvement and quality: Analyze operational performance (e.g., turnaround time, accuracy, denial drivers, customer contacts), support root-cause investigations, and implement corrective actions; participate in audits and quality reviews to sustain high standards.</li>
<li>Regulatory compliance and industry awareness: Stay current on applicable federal/state regulations, market trends, and internal compliance requirements; assess impacts to claims handling and proactively recommend updates to procedures, controls, training, and communications.</li>
<li>Claims adjudication (as assigned): Review and adjudicate supplemental health claims in accordance with plan provisions and procedures</li>
</ul>
Required Qualifications
<ul>
<li>Bachelor&rsquo;s degree (or equivalent combination of education and related experience).</li>
<li>3+ years of experience in supplemental health (voluntary benefits) claims operations and/or claims adjudication (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.).</li>
<li>Experience with process improvement methods, service-level management, and quality/audit programs.</li>
<li>Experience creating and maintaining operational documentation (SOPs, workflows, job aids) and communicating process changes to stakeholders.</li>
<li>Experience supporting implementations or migrations of claims platforms (requirements, configuration support, testing, training, go-live readiness).</li>
<li>Demonstrated training facilitation experience (live sessions, virtual training, train-the-trainer).</li>
<li>Demonstrated ability to interpret plan provisions/contract language and apply it consistently to claim scenarios.</li>
<li>Working knowledge of claims systems and operational controls (queue routing, decision rules, correspondence templates, work item management) and participation in testing/UAT.</li>
<li>Ability to analyze operational issues, identify root causes, and implement improvements that enhance accuracy, compliance, and cycle time.</li>
<li>Strong written and verbal communication skills, with the ability to explain claim outcomes and technical concepts clearly and professionally.</li>
</ul>
Preferred Qualifications
<ul>
<li>Experience applying Lean and Six Sigma methodologies to drive process improvements</li></ul> 


Salary Band: 6A

#LI-SC1

This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team building and collaboration.

We offer a comprehensive total rewards package designed to support you both at work and at home. Full‑time and part‑time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:
<ul>
<li>Medical &amp; prescription, dental, vision insurance</li>
<li>Health Savings Account &amp; Flexible Spending Accounts</li>
<li>Paid Time Off</li>
<li>10 weeks 100% paid parental leave (after completing 12 months of employment)</li>
<li>401(k) Plan with company match</li>
<li>Pension Plan</li>
<li>Company paid life &amp; disability insurance</li>
<li>Wellness Program &amp; Company paid employee assistance program</li>
<li>Clinic access subject to location* (*Indianapolis, Charlotte, Cincinnati)</li>
</ul>
If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York.

Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.

Disclaimer: American United Life Insurance Company (&ldquo;OneAmerica Financial&rdquo;) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, gender identity), age, physical or mental disability, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local law.

For all positions:

Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered.

To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.
Equal Opportunity Employer 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</div>

Supplemental Health Claims Manager

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.<div>
Position Summary
Provides strategic ownership of Claims workforce management by leveraging deep analytical expertise to forecast demand, develop capacity and staffing models, and optimize workforce utilization. Serves as the primary subject matter expert for Claims Workforce Management (WFM), partnering closely with senior leadership and cross‑functional stakeholders to support operational decision-making, performance outcomes, and scalability. Leads workforce planning initiatives, drives process improvements, and delivers actionable insights to ensure claims operations are staffed efficiently, consistently, and in alignment with business objectives.<ul><li>The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location</li></ul>
What you will do<ul><li>
Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.</li><li>
Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.</li><li>
Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.</li><li>
Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.</li><li>
Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.</li><li>
Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.</li><li>
Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.</li><li>
Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.</li><li>
Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.</li><li>
Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.</li><li>
Owns ongoing monitoring of claims performance against performance guarantees and operational commitments; proactively identifies risk and drives workforce reprioritization or resource reallocation to protect SLA, compliance, and financial outcomes.</li><li>
Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.</li></ul>
Required Qualifications<ul><li>
Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments</li><li>
Demonstrated expertise in forecasting, capacity planning, and workforce modeling</li><li>
Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations</li><li>
Proven ability to operate independently with a high level of ownership and accountability</li><li>
Strong communication skills and experience influencing leaders without direct authority</li><li>
Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques</li><li>
Experience partnering with senior leadership on staffing strategy and operational planning</li><li>
Experience designing or evolving workforce management operating models</li><li>
Strong business acumen with the ability to balance service, quality, cost, and compliance considerations</li></ul>
Education<ul><li>
Bachelor&rsquo;s degree preferred or equivalent combination of relevant experience, training, and professional development</li></ul></div>
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00 
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company&rsquo;s equity award program. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
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. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 07/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Senior Manager, Claims Workforce Management, Meritain TPA

Search 9812+ Claims operations manager jobs near you this June. New roles added regularly across leading industries. Apply today.

9812 claims operations manager jobs Near Me

Claims Operations Manager-Payment Accuracy

Claims Adjudication Manager

Claims Manager, Casualty and Specialty

Supplemental Health Claims Manager

Senior Manager, Claims Workforce Management, Meritain TPA

Senior Manager, Claims Workforce Management, Meritain TPA

Senior Manager, Claims Workforce Management, Meritain TPA