Supervisor, Claim Operations

Claim Supervisor

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Hybrid in Hartford, CT required.

Claim Supervisor: Responsible for the overall supervision of Medical Claim Processing employees. Achieve superior service performance through an integrated process of operational, quality, medical cost and resource management tools and applications; meeting and/or exceeding department and company goals.

Fundamental Components:

• Develop, train, evaluate and coach staff to provide cost effective claim review/processing and claim service while ensuring compliance and quality standards are met.
• Manage and monitor daily inventory to ensure production standards are met and/or exceeded.
• Allocate resources to meet volume and performance standards including Key Performance Metrics (KPMs) and Performance Guarantees.
• Must have the ability to work collaboratively, ability to communicate effectively with candor, ability to identify risks early, strong organizational skills, and strong leadership skills including staff development.
• Identify and execute team process improvement.
• Assess individual and team performance using all available tools/applications and provide timely results and candid feedback regularly and by using mid-year and annual scorecards.
• Acts as a liaison between staff and other areas, including management, plan sponsors, provider teams, communicating workflows, results, ideas, and solutions.
• Utilize available incentive programs to reward, recognize, and celebrate team and individual successes.
• Demonstrates the ability to be flexible and creative in a fast paced, constantly changing environment.
• Candidate will be expected to effectively apply and enforce Aetna/CVS HR policies and practices.
• The candidate for this position will need to present a positive, professional image of the company at all times.

Required Qualifications:

• 1+ Year prior work experience in an ACAS claim processing role.
• The candidate must have success in claim processing/service, leadership, oral and written communication skills, keeping commitments and meeting deadlines, and strong business knowledge. (2+ years preferred)
• Proven track record of successfully dealing with multiple priorities, tasks, and fluctuating deadlines.
• Understands projecting work volumes and workload management preferred.
• Prior experience working in a quality assurance and production capacity.

Preferred Qualifications:

• Prior experience working in a quality assurance and production capacity.

Education: Associates degree, or High School Diploma and equivalent work experience.

Anticipated Weekly Hours 40

Time Type Full time

Pay Range The typical pay range for this role is: $43,888.00 - $93,574.00

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.