Exec Dir – Adjudication Data services

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.

Position Summary

The Executive Director oversees the Adjudication Data Services, including Member eligibility, Member Data Transition, and Claim downstream application systems portfolio for CVS Health. This role involves working with business stakeholders, technology teams, vendors, and external partners to align technology solutions with strategic goals and objectives.

• Lead a cross-functional team of technology professionals supporting the portfolio assets and large data workloads on the IBMi series platform, Azure, and Google Cloud.
• Expertise in utilizing cloud technologies to develop and implement modern data architecture solutions. Ability to analyze use cases and create innovative solutions that meet business needs.
• Partner and co-lead solution engineering discipline, guiding and mentoring talent in implementing solutions across various technology platforms.
• Collaborate with stakeholders to understand business processes, challenges, and objectives, translating these into effective implementation plans.
• Assess issue risks and develop mitigation strategies to minimize impact on clients.
• Provide strategic direction to co-develop and execute our modernization vision on ‘Adjudication as a Service’ by creating single sources of truth within domain contexts.
• Focus on strategies to reduce the cost of change, deploy automation, increase speed to market, enhance technology relevance, and ensure platform scalability and serviceability.
• Establish and implement application development standards to promote the modularization of adjudication functions and the creation of domain services for consistent client and member experiences.
• Manage overall delivery, ensuring quality, design, timeliness, budget adherence, and alignment with key OKRs and KPIs.
• Oversee IT budget, resources, and vendors delivering IT projects and services in alignment with OKRs.
• Maintain effective communication and collaboration with business stakeholders, vendors, and external partners, meeting business requirements and expectations and resolving issues or escalations.
• Ensure compliance of systems and applications with company policies, standards, and regulations, identifying, assessing, and mitigating risks and controls.
• Promote a culture of innovation and strategic thinking within the organization, encouraging new ideas and continuous improvement in business and technical processes.
• Inspire and mobilize teams towards talent development, creating an environment that fosters the acquisition of new skills and continuous improvement.
• Address challenges related to organic growth, system performance, and end-of-life software/hardware while ensuring compliance with regulatory requirements.

Required Qualifications

The ideal candidate will possess a strong work ethic, demonstrate proactive initiative, and maintain high productivity in a dynamic, collaborative environment. This role provides extensive exposure to all facets of the company’s operations, along with significant interaction with senior business leaders. The candidate should exhibit the following key attributes:

• 12+ years in Healthcare IT, including 4 years at Director+ level, leading teams in application/system architecture & development on AS/400 and Cloud technologies.
• 10+ years in client-facing support, handling production issues, cross-functional resolution, executive reporting, and SLA adherence.
• Skilled at managing cross-functional issues and leading diverse teams without direct authority.
• 5+ years in leading and scaling support operations.
• Expertise in AS/400 and related technologies (e.g., Mimix, CL, RPG/RPGLE, COBOL, SYNON, CA/2E, SQL, Aldon, JDBC, ODBC, Direct Connect, Rational Developer, iNavigator, PEX, Database concepts).
• Proficient in cloud engineering, designing scalable and secure cloud infrastructure.
• Strategic planning for enterprise applications, focusing on growth, performance tuning, and optimization.
• Analyzed enterprise platforms to identify deficiencies and recommend improvements.
• Experienced in budgets, strategic planning, process enhancement, technical leadership, HR management, and staff development.
• Available to travel up to 10%.

Preferred Qualifications

• Strong knowledge and experience in IT vendor management and IT service management methodologies and frameworks.
• Demonstrated leadership through transformation initiatives.
• Proven experience in a product-led transformation and mature operations.
• Strong people leadership capabilities with the 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.
• Experience with newer SDLC methodologies like Agile, SCRUM, and XP.
• Knowledge of CMS Medicare regulations.

Education

Bachelor’s degree in computer science, information systems, or related field, or equivalent work

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 Health

We anticipate the application window for this opening will close on: 03/28/2025

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