Manager, Claim Processing

CVS Health

Claims Processing Manager overseeing claims processing team operations at CVS Health. Ensuring accuracy, compliance, and efficiency in claims handling with strategic leadership.

Posted 5/15/2026full-timeRemote • Maryland, Massachusetts, New York, South Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $66,330 - $145,860 per yearWebsite

About the role

Key responsibilities & impact

Manages day-to-day activities of team by providing strategic leadership and overseeing the operations of the claims processing team(s)
Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics
Addresses any complex or escalated claims issues to provide guidance to claim processors in handling challenging cases
Designs quality control processes to ensure the accuracy and consistency of claim processing
Assists with the development of the claim processing budget by monitoring expenses and identifying cost-saving opportunities
Analyzes claim processing data and generates reports to track and evaluate key performance metrics
Collaborates with other departments to ensure effective communication and coordination in the claim processing workflow
Ensures compliance with industry regulations and company policies

Requirements

What you’ll need

5–7 years of experience in healthcare claims and/or operations
5–7 years of demonstrated leadership experience, including team oversight and performance management
strong execution and delivery capabilities, including planning, implementation, and ongoing support
strong problem‑solving and sound decision‑making capabilities in complex environments
proven ability to collaborate effectively across teams and build strong partnerships with diverse stakeholders
exhibits a growth mindset, including adaptability, continuous learning, and the ability to develop self and others
strong written and verbal communication skills
Certified Billing and Coding Specialist (CBCS) preferred
Candidates located on the East Coast preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingquality control processesdata analysisperformance metricsbudget developmentcost-saving opportunitiesmedical claims processing

Soft Skills

strategic leadershipproblem-solvingdecision-makingcollaborationcommunicationadaptabilitycontinuous learningteam oversightperformance management

Certifications

Certified Billing and Coding Specialist (CBCS)