Workforce Management Analyst, Claims Operations - Meritain TPA

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.

Applies in-depth knowledge of Claims Operations and workforce management principles to optimize staffing, capacity, workload distribution, and operational performance. Analyzes claims inventory, receipts, production, staffing, utilization, and productivity trends to support proactive workforce planning and resource allocation. Develops forecasts and capacity models that help Claims leadership anticipate staffing needs, identify capacity gaps, balance workloads, and align available resources to business priorities.

Translates complex operational data into actionable insights and recommendations that support service performance, inventory management, and timely claims processing. Partners closely with Claims Operations leadership and cross-functional stakeholders to improve forecasting, workforce utilization, operational reporting, and resource planning.

• Analyzes claims receipts, production, inventory, aging, staffing, productivity, and utilization trends to identify capacity needs, workload imbalances, and operational risks.
• Develops and maintains Claims Operations demand and capacity forecasts using historical volumes, production trends, staffing assumptions, employee ramp, PTO/LOA, overtime, and other operational factors.
• Builds and maintains capacity models that compare available productive capacity to projected claims demand and inventory requirements, identifying potential staffing surpluses or gaps.
• Supports claims inventory and forecasting, including projected receipts, completions, inventory movement, and capacity scenarios across claims work types and inventory segments.
• Monitors workforce utilization and evaluates the impact of production and non-production activities.
• Evaluates workload distribution across Claims teams and identifies opportunities to improve staffing allocation, workload balancing, productivity, and use of specialized claims skills.
• Partners with Claims leadership to align available capacity with operational priorities.
• Performs scenario modeling to evaluate the operational impact of changes in staffing, overtime, vendor capacity, training/ramp assumptions, utilization, automation, productivity, and incoming claims volume.
• Develops recurring reporting and workforce insights that provide Claims leaders with visibility into capacity versus demand, inventory trends, productivity, utilization, staffing, and emerging operational risks.
• Translates workforce and operational data into clear recommendations for Claims Operations leadership.
• Partners with Claims leadership and other cross-functional stakeholders to ensure staffing and workforce strategies support operational needs.
• Identifies and implements opportunities to improve forecasting, reporting, workload management, resource utilization, and workforce planning processes, including appropriate use of automation and analytical tools.
• Supports development and maintenance of workforce planning methodologies, metric definitions, documentation, and governance to promote consistency and accuracy across Claims Operations.

• Minimum of 3 years of experience in workforce management, operations analytics, capacity planning, forecasting, claims operations, or a related operational role.
• Experience analyzing operational data and translating…