Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.If you are looking for a leadership role where you can make a significant impact and are passionate about doing what's right, consider the role of Executive Director of Adjudication Commercial & Strategic
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In this high-profile position reporting to Vice President of Adjudication Services portfolio, you will be responsible for the overall transformation, ongoing modernization, and developing an automation strategy for our Claim adjudication ecosystem. You will lead the Adjudication Commercial & Strategic portfolio and drive all project initiatives to help achieve Caremark business & financial goals. Join us in shaping the future of CVS Health IT.
Position Summary
The Executive Director leads the Claim Adjudication, Commercial & Strategic portfolio that develops and operates the systems and processes for CVS Health. This leader collaborates with the business stakeholders, technology teams, vendors, and external partners to align the technology solutions with the strategic goals and objectives.
- Lead a dynamic cross-functional team of over 100 technology professionals. Support the Claim adjudication portfolio on the IBMi series platform and Claim integration capabilities across Cloud technology platforms.
- Strong expertise in leveraging cloud technologies to develop and implement cutting edge technology solutions. Demonstrated ability to analyze use cases and drive innovative solutions that meet business needs.
- Partner and co-lead solution engineering discipline, guiding and mentoring key talent in implementing solutions across a wide range of technology platforms
- Serve as a transformational leader, providing strategic direction to co-develop and co-execute our modernization vision for 'Adjudication as a Service
- Focus on key strategies to reduce the cost of change, deploy automation, increase speed to market, enhance technology relevance, and ensure scalability and resilience of the core platforms.
- Establish and implement application development standards to promote the modularization of relevant adjudication functions, creation of domain services for consistent client and member experience
- Manage the overall delivery, ensuring the quality, design, timeliness, and budget adherence and meeting the key OKRs and KPIs.
- Manage the IT budget, resources, and vendors delivering the IT projects and services in alignment with OKRs
- Establish and maintain effective communication and collaboration with the business stakeholders, vendors, and external partners, meeting the business requirements and expectations, and resolving any issues or escalations.
- Ensure the compliance of the systems and applications with the company policies, standards, and external regulations, and identify, assess, and mitigate risks and controls.
- Fosters a culture of innovation and strategic thinking within the organization, encouraging the generation of new ideas and driving continuous improvement in business / technical processes and practices.
- Proven ability to inspire and mobilize teams towards talent development, fostering an environment that encourages the acquisition of new skills and talent elevation.
- Proactively identify and address challenges related to organic growth, system performance, and end-of-life software/hardware, while ensuring compliance with all regulatory requirements.
Required Qualifications
- 12+ years of Healthcare IT experience in a large-scale complex technology environment, including 4 years' experience in a Director+ level role, leading IT teams focused on application/system architecture & application development of the AS/400 platform and modernization using modern technologies.
- Experience with industry leading expertise in AS/400 and similar technologies, including but not limited to Mimix, CL, RPG/RPGLE, COBOL, SYNON, CA/2E, SQL, Aldon, JDBC, ODBC, Direct Connect, Rational Developer, iNavigator, PEX and Database concepts.
- Experience in cloud development and engineering, architecting solutions for major cloud platforms using Microservices, with a focus on designing and implementing scalable and secure cloud infrastructure
- Experience in leading multiple large enterprise initiatives simultaneously by leading both direct and indirect teams
- Experience leading strategic planning for enterprise applications including planning related to scalable growth, performance tuning, and optimization of the systems.
- Experience analyzing the enterprise platforms and related technologies to detect critical deficiencies and recommend solutions for improvement.
- Experience in creating and running budgets, strategic planning, process enhancement, technical leadership, HR management and staff development.
- Ability to travel up to 10% of the time.
- Strong knowledge and experience in IT vendor management, and IT service management methodologies and frameworks.
- Demonstrated leadership in driving transformation initiatives with clear ROI
- Proven experience in a product led transformation and mature operations.
- Strong people leadership capabilities with a strong ability to build a high performing team, through formal training, diverse assignments, coaching, mentoring, and other techniques.
- Strong communication, collaboration, and stakeholder management skills, with the ability to influence and negotiate at all levels.
- Strong analytical, problem-solving, and decision-making skills, with the ability to drive innovation and continuous improvement.
- RxClaim adjudication application expertise.
- Experience with distributed systems and portable languages like Java.
- Experience with newer SDLC methodologies like Agile, SCRUM & XP.
- Knowledge with CMS Medicare regulations.
Bachelor's degree in computer science, information systems, or related field, or equivalent work
experience.Pay Range
The typical pay range for this role is:$175,100.00 - $334,750.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.