Claims Operations, Senior Manager Meritain TPA

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Operations, Senior Manager Meritain TPA based in United States.

This senior leadership role oversees claims operations and service delivery across self-funded, short-term medical, and/or dental claims. You will lead a large team responsible for timely, accurate, and high-quality claims adjudication while driving operational excellence. The position combines strategic planning, people leadership, performance management, and continuous process improvement. You will shape service strategies that strengthen member, provider, and plan sponsor satisfaction and loyalty. The role also involves leveraging business intelligence, healthcare technology, and industry best practices to improve efficiency and communication. Success requires a customer-centric leader who can navigate complex operational challenges and translate strategy into measurable results.

Accountabilities:

• Lead and oversee a claims operations team responsible for the timely and accurate adjudication of self-funded, short-term medical, and/or dental claims, maintaining strong service and quality standards.
• Develop and implement operational strategies that improve service delivery, efficiency, coordination, and the overall experience of members, providers, and plan sponsors.
• Manage team resources, budgets, and operational priorities to optimize performance, productivity, and allocation of capabilities across the organization.
• Monitor service quality, compliance, and performance metrics, implementing quality assurance programs and corrective actions where needed to maintain regulatory and industry standards.
• Identify and implement process improvements that enhance operational effectiveness, streamline workflows, and support evolving business and healthcare needs.
• Research industry trends, emerging technologies, and best practices to identify opportunities for innovation, service expansion, professional development, and operational growth.
• Leverage healthcare technology and business intelligence to improve decision-making, communication, information sharing, and service outcomes while fostering a positive, collaborative, and service-oriented culture.

Requirements:

• Minimum 7 years of professional experience in claims operations, with substantial experience in healthcare; experience in third-party administration (TPA) and self-funded plans is highly preferred.
• Demonstrated leadership experience managing large teams, with the ability to develop talent, provide coaching, and create an environment focused on accountability and continuous growth.
• Strong execution and delivery skills, including the ability to plan effectively, manage priorities, deliver against objectives, and provide ongoing operational support.
• Strong business intelligence capabilities and the ability to use data, performance metrics, and operational insights to inform decisions and improve outcomes.
• Excellent collaboration and teamwork skills, with the ability to work effectively across functions and stakeholder groups.
• Advanced problem-solving and decision-making abilities, combined with sound judgment and the ability to address complex operational challenges.
• A growth mindset characterized by agility, adaptability, continuous learning, and a commitment to developing both yourself and others; dental claims experience is preferred, and a bachelor's degree, specialized training, or relevant professional qualification is preferred.

Benefits:

• Base salary range of $75,400 to $182,549, with the actual offer determined by factors such as experience, education, geography, and other relevant considerations.
• Eligibility for additional compensation through bonus, commission, or short-term incentive programs, along with participation in an equity award program.
• Comprehensive benefits package designed to support employees and their families, including medical, dental, and vision coverage.
• Paid time off and retirement savings options to support long-term financial well-being.
• Wellness programs and additional resources supporting physical, emotional, and financial well-being.
• Full-time remote/work-from-home opportunities, with eligibility and location requirements varying by position and work location.
• A collaborative and inclusive work environment focused on professional development, belonging, innovation, and meaningful impact in healthcare services.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.