Lead Director Claims Operations Meritain TPA

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'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 - helping to simplify health care one person, one family and one community at a time.Brief OverviewProvides strategic leadership, management oversight, and cross‑functional partnership to ensure exceptional customer experiences and satisfaction. This role is responsible for developing and executing Claims Operations strategy; leading a large, multi‑layered Claims organization; monitoring quality, performance, and compliance; resolving escalated issues; and driving continuous process improvement.Applies strong leadership capabilities, a customer‑centric mindset, and advanced problem‑solving skills to drive customer loyalty, retention, and advocacy, while cultivating a positive, service‑oriented, and performance‑driven culture.The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub locationWhat You Will DoLead a team of up to 20 people leaders with a total span of control exceeding 400 Claims Operations resourcesProvide strategic direction and operational leadership for Claims processing delivery, quality, and customer experienceDevelop and execute strategies to optimize Claims Operations performance, efficiency, and scalabilityImplement industry best practices and continuous improvement methodologies (e.g., Lean, Six Sigma, Agile) to streamline processes and improve outcomesEvaluate, select, and integrate innovative technologies and systems to enhance Claims Operations and customer support capabilitiesPartner closely with IT, data management, compliance, finance, and other cross‑functional stakeholders to align operational execution with enterprise strategyManage workforce planning, capacity models, and resource allocation to ensure services are delivered on time, within budget, and at required quality levelsEstablish, monitor, and manage key performance indicators (KPIs), SLAs, and quality metricsDrive strong performance management, accountability, and results across leadership teamsFoster a customer‑centric culture focused on empathy, effective communication, quality, and problem resolutionMonitor customer feedback, trends, and escalations; implement actions to improve satisfaction, retention, and overall experienceLeverage business intelligence, data analytics, and operational insights to drive informed decision‑makingStay current on healthcare claims, TPA industry trends, regulatory changes, and emerging technologies to continuously enhance service deliveryMinimum RequirementsMinimum of 10 years leading large‑scale Claims Operations organizations with deep understanding of healthcare claims operations, adjudication, and preferably in TPA operating modelsHealthcare experience within the TPA sector of healthcare delivery highly preferredTrack record of building strong leadership pipelines, succession planning, and employee engagementProven experience managing enterprise‑scale operations with complex workflowsStrong execution and delivery skills, including planning, implementation, and operational sustainmentAdvanced proficiency in business intelligence and data‑driven decision makingDemonstrated ability to collaborate effectively in matrixed, cross‑functional environmentsStrategic problem solving and decision makingLeadership agility and growth mindsetDeveloping leaders and high‑performing teamsPreferred QualificationsDemonstrated success leading large‑scale operational transformation and change initiativesWorking knowledge of healthcare regulatory, compliance, and audit requirements (e.g., HIPAA, CMS, state regulations)Experience leading or supporting claims system implementations, optimization, or modernization effortsFamiliarity with automation, AI, workflow tools, and digital claims technologiesStrong financial acumen, including budget ownership, cost management, and workforce optimizationExperience leading remote or hybrid Claims Operations workforces (if applicable)EducationBachelor's degree preferred/specialized training/relevant professional qualification.Pay RangeThe typical pay range for this role is:$100,000.00 - $231,540.00This 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'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 peopleWe 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: 04/24/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Created: 2026-04-13