Talent.com
Oak St. Health
Senior Manager, Project Program Management (Claim Operations)Oak St. Health • Hartford, CT, United States
No longer accepting applications
Senior Manager, Project Program Management (Claim Operations)

Senior Manager, Project Program Management (Claim Operations)

Oak St. Health • Hartford, CT, United States
22 days ago
Salary
$82,940.00 yearly
Job type
  • Full-time
Job description

CVS Health Opportunity

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.

This individual contributor position:

  • Designs, develops, and leads the Aetna Business Unit Claim Operations Review program, providing ongoing assessments of the health of end-to-end claim operational and financial flows, analysis of operational issues, and insight into factors in the operational environment that could affect the actuarial reserve setting process.
  • Leads and oversees the construction of analysis and presentation deck by members of the Claim Operations Analytics team; Presents the materials during the twice-monthly Operations Review Calls.
  • Designs, conducts, or leads ad hoc operational analysis to meet Service Operations information needs.
  • Maintains various routine reports and information sources supporting Commercial and Medicare Service Operations constituents.

Required Qualifications:

  • In-depth understanding of the medical/dental claim operational lifecycle including: Provider Billing/coding process, Claim Intake & Distribution, Pre-adjudication process, Claim editing, Pended Claim Inventory management, Auto-adjudication, Payment Process, Appeals, and Rework.
  • Demonstrated understanding of actuarial reserving concepts and the interaction between claim operations and reserve modeling.
  • 5 years' experience designing appropriate metrics and conducting "large population" (100K+) claim analyses to monitor and evaluate the quality and speed of operational flows through claim lifecycle phases.
  • 5 years' experience developing and delivering professional analytical presentations to senior leaders.
  • Demonstrated adaptability to changing operational conditions, including development of innovative approaches for understanding the impact of an evolving operational environment.
  • Demonstrated experience in peer leadership: leading others through influence, rather than through formal organization authority.
  • MS Excel power-user.
  • 3 years' SQL, SAS, GCP or related query-construction experience.

Preferred Qualifications:

  • 3+ years' experience with Aetna claim systems and operational environment.
  • 3+ years' hands-on experience querying large-scale raw operational claim data sets, including data cleaning and conditioning.

Pay Range: $82,940.00 - $182,549.00

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 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 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 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.

Create a job alert for this search

Senior Manager, Project Program Management (Claim Operations) • Hartford, CT, United States

Similar jobs

Director Category Management, Software Category

The HartfordHartford, CT, United States
Full-time

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies.Working here means having every opportunity to achieve your goals – and t... Show more

 • Promoted

Manager Trainee - Operations (Travel Program; Relocation Required)

Biolife Plasma ServicesSPRINGFIELD, Massachusetts, United States
$54,400.00 yearly
Full-time

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Tak... Show more

 • Promoted

Claims Manager I, Miscellaneous Medical Facilities Professional Liability

Liberty Mutual Insurance GroupWeatogue, CT, United States
Full-time

Join Liberty Mutual as a Claims Manager and help lead a team committed to delivering exceptional service, driving results and making a meaningful difference for our customers every day!.Liberty Mut... Show more

 • Promoted

Project Acquisition Manager (remote)

Endress+HauserSpringfield, MA, United States
Remote
Full-time

At Endress+Hauser, progress happens by working together.As the global leader in measurement instrumentation, our 17,000 employees shape the future in the field of process automation.Whether develop... Show more

 • Promoted

Professional Services Project Manager (Remote/US)

Lemonedge TechnologySpringfield, MA, United States
Remote
Full-time

Professional Services Project ManagerWe are looking for a Professional Services Project Manager to lead client implementation and change projects across our global customer base.You'll be a central... Show more

 • Promoted

Senior Procurement Project Specialist

HoneywellNorthford, CT, United States
Full-time

Senior Procurement Project Specialist.As a Senior Procurement Project Specialist here at Honeywell, you will be responsible for overseeing and managing the organization's procurement projects and i... Show more

 • Promoted

Practice Consultant Senior

FisglobalMadison, CT, United States
Full-time

Every day, our teams innovate across the world of finance.We collaborate to work smarter, while making a difference.We believe in diversity and inclusivity, giving a voice to everyone on the team.A... Show more

 • Promoted

Clinical Support Associate- 24 Hour/Evening-Stepdown/Progressive Care Unit-Milne 1

Gaylord Specialty HealthcareWallingford, CT, United States
Part-time

Clinical Support Associate- 24 Hour/Evening-Stepdown/Progressive Care Unit-Milne 1.Job Category: Nursing/Nursing Support Requisition Number: CLINI002007.Part-Time On-site WALLINGFORD, CT 06492, USA... Show more

 • Promoted

Senior Claims Examiner

HiscoxWest Hartford, CT, United States
Full-time

Build a brilliant future with Hiscox.Bring your passion and enthusiasm to our team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance pro... Show more

 • Promoted

Program Manager - Remote

HCL Global Systems, Inc.Hartford, CT, United States
Remote
Full-time

Type Category Qualification Description Competency Required Skills Others Grants Management System implementation Proficient (4-6 Years) Yes Skills Others Project management Expert (10Years) Yes Sk... Show more

 • Promoted

Project Manager_ Remote

StaffingHartford, CT, United States
Remote
Full-time

Project ManagerLocation:RemoteDuration:12Months ContractJob Description:As a Delivery Leader you'll be responsible for delivering value and outcomes.Delivery leaders are expected to have an end-to-... Show more

 • Promoted

Healthcare Product Manager (Payments & Health Plans) Remote

Conexess Group, LLCWallingford, CT, United States
Remote
Full-time

Conexess Group is aiding a large healthcare client in their search for a Product Manager in a remote capacity.This is a long-term opportunity with a competitive compensation package.Please note we ... Show more

 • Promoted

Suitability Principal

Massachusetts Mutual Life InsuranceSpringfield, MA, United States
Full-time

As a Suitability Principal, you will be responsible for conducting back-office suitability reviews and firm-acceptance for accounts clearing through National Financial Services (NFS).You will also ... Show more

 • Promoted

Senior Buyer

Howmet AerospaceBranford, CT, United States
Permanent

The selected candidate will report to the Procurement Segment Manager and provide support to the Winsted and Branford Facilities & be located in Winsted, CT to ensure Business Unit goals are met th... Show more

 • Promoted

Claims Director | Full-Time | Remote

Oak View GroupEast Hartford, CT, United States
Remote
Full-time

Oak View GroupOak View Group is the global leader in venue development, management, and premium hospitality services for the live event industry.Offering an unmatched, 360-degree solution set for a... Show more

 • Promoted

Digital Accessibility Project Manager (Remote)

GSK SolutionsHartford, CT, United States
Remote
Full-time

Job Title :Digital Accessibility Project Manager (Remote)Location :Hartford, CTDuration :12 MonthsPay Rate :85 / hr on C2C / 1099 all inclusive (OR) $75 / hr on W2Job DescriptionThe client is launc... Show more

 • Promoted

Store Manager, Clinton Premium Outlets - Clinton, CT

Michael KorsClinton, CT, United States
Full-time

Michael Kors is always interested in hearing from talented, globally-minded individuals with a passion for fashion.If you enjoy working in a creative, fast-paced environment, then we would love to ... Show more

 • Promoted

Senior Claims Specialist

Odyssey GroupAvon, CT, United States
Full-time

The Senior Claims Specialist is responsible for managing all aspects of complex third-party liability claims, including class actions and high exposure matters, from inception through conclusion, b... Show more

 • Promoted

Change Management Program Leader Farmington, CT.

ESRhealthcare and EXEC STAFF RECRUITERSFarmington, Connecticut, United States
Full-time
Quick Apply

Change Management Program Leader in Farmington, CT.Summary: A Senior Change Management Consultant (Senior CMC) partners with the Company Change Management Team Center of Experts (CoE), project team... Show more

Project Manager II - Remote

Capitol LightHartford, CT, United States
Remote
Full-time

We are looking for a Project Manager II to join our Capitol Light team Remote! Summary:The Project Manager II is responsible for managing moderate complexity project business by placing orders, tra... Show more