Senior Manager, Claims Workforce Management, 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.

Position Summary Provides strategic ownership of Claims workforce management by leveraging deep analytical expertise to forecast demand, develop capacity and staffing models, and optimize workforce utilization. Serves as the primary subject matter expert for Claims Workforce Management (WFM), partnering closely with senior leadership and cross‑functional stakeholders to support operational decision-making, performance outcomes, and scalability. Leads workforce planning initiatives, drives process improvements, and delivers actionable insights to ensure claims operations are staffed efficiently, consistently, and in alignment with business objectives.
* The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location

What you will doOwns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.

Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.

Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.

Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.

Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.

Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.

Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.

Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.

Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.

Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.

Owns ongoing monitoring of claims performance against performance guarantees and operational commitments; proactively identifies risk and drives workforce reprioritization or resource reallocation to protect SLA, compliance, and financial outcomes.

Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.

Required Qualifications Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments

Demonstrated expertise in forecasting, capacity planning, and workforce modeling

Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations

Proven ability to operate independently with a high level of ownership and accountability

Strong communication skills and experience influencing leaders without direct authority

Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques

Experience partnering with senior leadership on staffing strategy and operational planning

Experience designing or evolving workforce management operating models

Strong business acumen with the ability to balance service, quality, cost, and…