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Lead Director Adjustments Operations Meritain TPA

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States

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Category:
Customer Service

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Contract Type:
Employment contract

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Salary:

100000.00 - 231540.00 USD / Year
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Job Description:

Provides strategic leadership, management oversight, and cross‑functional partnership to ensure exceptional customer experiences and satisfaction. This role is responsible for developing and executing Adjustments, Flex/CDHP, Front End, and Data Operations strategy as well as process automation and outsourcing; leading a multi‑layered 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.

Job Responsibility:

  • Lead a team of 10 people leaders with a total span of control of 171 resources
  • Provide strategic direction and operational leadership for Adjustments and Recoveries processing delivery, quality, and customer experience
  • Develop and execute strategies to optimize Adjustments 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 Adjustments and Recoveries Operations and customer support capabilities
  • Partner closely with IT, data management, compliance, finance, and other cross‑functional 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 customer‑centric 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 decision‑making
  • Stay current on healthcare claims, TPA industry trends, regulatory changes, and emerging technologies to continuously enhance service delivery

Requirements:

  • Minimum of 10 years leading Claims & Adjustments 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 enterprise‑scale operations with complex workflows
  • Strong execution and delivery skills, including planning, implementation, and operational sustainment
  • Advanced proficiency in business intelligence and data‑driven decision making
  • Demonstrated ability to collaborate effectively in matrixed, cross‑functional environments
  • Strategic problem solving and decision making
  • Leadership agility and growth mindset
  • Developing leaders and high‑performing teams
  • Demonstrated success leading large‑scale operational transformation and change initiatives
  • Working knowledge of healthcare regulatory, compliance, and audit requirements (e.g., HIPAA, CMS, state regulations)
  • Experience leading or supporting 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 Operations workforces (if applicable)
  • Bachelor's degree preferred/specialized training/relevant professional qualification

Nice to have:

  • Demonstrated success leading large‑scale operational transformation and change initiatives
  • Working knowledge of healthcare regulatory, compliance, and audit requirements (e.g., HIPAA, CMS, state regulations)
  • Experience leading or supporting 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 Operations workforces (if applicable)
  • Bachelor's degree preferred/specialized training/relevant professional qualification
What we offer:
  • medical
  • dental
  • vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • bonus
  • commission or short-term incentive program
  • equity award program

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 17, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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