Lead Director Claims Operations Meritain TPA

Weu2019re building a world of health around every individual u2014 shaping a more connected, convenient and compassionate health experience. At CVS Healthu00ae, youu2019ll 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 u2013 helping to simplify health care one person, one family and one community at a time. Brief Overview Provides strategic leadership, management oversight, and crossu2011functional partnership to ensure exceptional customer experiences and satisfaction. This role is responsible for developing and executing Claims Operations strategy; leading a large, multiu2011layered Claims organization; monitoring quality, performance, and compliance; resolving escalated issues; and driving continuous process improvement. Applies strong leadership capabilities, a customeru2011centric mindset, and advanced problemu2011solving skills to drive customer loyalty, retention, and advocacy, while cultivating a positive, serviceu2011oriented, and performanceu2011driven culture. _The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location_ What You Will Do + Lead a team of up to 20 people leaders with a total span of control exceeding 400 Claims Operations resources + Provide strategic direction and operational leadership for Claims processing delivery, quality, and customer experience + Develop and execute strategies to optimize Claims Operations performance, efficiency, and scalability + Implement industry best practices and continuous improvement methodologies (e.g., Lean, Six Sigma, Agile) to streamline processes and improve outcomes + Evaluate, select, and integrate innovative technologies and systems to enhance Claims Operations and customer support capabilities + Partner closely with IT, data management, compliance, finance, and other crossu2011functional stakeholders to align operational execution with enterprise strategy + Manage workforce planning, capacity models, and resource allocation to ensure services are delivered on time, within budget, and at required quality levels + Establish, monitor, and manage key performance indicators (KPIs), SLAs, and quality metrics + Drive strong performance management, accountability, and results across leadership teams + Foster a customeru2011centric culture focused on empathy, effective communication, quality, and problem resolution + Monitor customer feedback, trends, and escalations; implement actions to improve satisfaction, retention, and overall experience + Leverage business intelligence, data analytics, and operational insights to drive informed decisionu2011making + Stay current on healthcare claims, TPA industry trends, regulatory changes, and emerging technologies to continuously enhance service delivery Minimum Requirements + Minimum of 10 years leading largeu2011scale Claims Operations organizations with deep understanding of healthcare claims operations, adjudication, and preferably in TPA operating models + Healthcare experience within the TPA sector of healthcare delivery highly preferred + Track record of building strong leadership pipelines, succession planning, and employee engagement + Proven experience managing enterpriseu2011scale operations with complex workflows + Strong execution and delivery skills, including planning, implementation, and operational sustainment + Advanced proficiency in business intelligence and datau2011driven decision making + Demonstrated ability to collaborate effectively in matrixed, crossu2011functional environments + Strategic problem solving and decision making + Leadership agility and growth mindset + Developing leaders and highu2011performing teams Preferred Qualifications + Demonstrated success leading largeu2011scale operational transformation and change initiatives + Working knowledge of healthcare regulatory, compliance, and audit requirements (e.g., HIPAA, CMS, state regulations) + Experience leading or supporting claims system implementations, optimization, or modernization efforts + Familiarity with automation, AI, workflow tools, and digital claims technologies + Strong financial acumen, including budget ownership, cost management, and workforce optimization + Experience leading remote or hybrid Claims Operations workforces (if applicable) Education + Bachelor's degree preferred/specialized training/relevant professional qualification. Pay Range The typical pay range for this role is: $100,000.00 - $231,540.00 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 companyu2019s 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 fullu2011time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellu2011being 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: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran u2014 committed to diversity in the workplace.

Created: 2026-04-10