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.

Position Summary

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.

What you will do

• 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.

Required Qualifications

• 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 findings into actionable recommendations.
• Demonstrated proficiency working with data, spreadsheets, reporting tools, workforce management systems, or similar analytical platforms.
• Strong analytical, problem-solving, and decision-making skills.
• Strong communication, information management, and organization skills with the ability to collaborate effectively across operational and functional teams.
• Proactive self-starter who takes ownership, quickly learns new concepts, identifies opportunities for improvement, and independently drives issues toward resolution.

Preferred Qualifications

• Experience supporting health care claims operations, health insurance operations, or another transaction-based operational environment.
• Experience with claims inventory management, production forecasting, capacity planning, workload balancing, or workforce utilization analysis.
• Experience developing forecasts or scenario models using volumes, productivity, staffing, and capacity assumptions.
• Experience analyzing operational metrics such as receipts, completions, inventory aging, productivity, utilization, staffing levels, and service performance.
• Experience creating reports, dashboards, or operational analyses used to support leadership decision-making.
• Ability to identify emerging workforce or inventory risks and translate data into practical operational recommendations.
• Strong communication and cross-functional collaboration skills.

Education

• High school diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

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.

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/27/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.