Executive Director, Appeals Process & Technology – Aetna

CVS Health; Hartford (CT); Vor Ort; USD 132.000 - 303.000; Vollzeit

Zusammenfassung

CVS Health in Hartford, CT is seeking an Executive Director, Appeals Process & Technology to lead a cross-functional program migrating Grievances & Appeals processes to a modern technology platform, driving efficiency and compliance.

The role requires an operator who influences at the executive level, builds high-performing teams, and partners with Product, Technology, Compliance and Operations to deliver scalable solutions and measurable business outcomes.

Qualifikationen

• 15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
• Proven experience leading leaders and large‑scale, front‑line operational teams.
• Demonstrated experience leading significant technology or platform initiatives.
• Strong health plan operations experience (Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions).
• Strong operational acumen including workforce management, workflow optimization, and compliance.
• Proven ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions.
• Experience developing business cases, prioritizing investments, managing budgets, and using data to drive decisions.
• Working knowledge of CMS, state regulatory requirements, HIPAA, privacy, and audit readiness.
• Executive presence with the ability to influence senior leaders.

Aufgaben

• Align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows and reporting capabilities.
• Define and communicate the long-term business strategy for technology products supporting A&G teams, including KPIs and success measures.
• Provide executive guidance to ensure business requirements are integrated into technology delivery plans.
• Lead platform migration strategy, planning, and execution with DDAT and Operations leaders.
• Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims and other partners.

Kenntnisse

Healthcare leadership

Operations excellence

Executive influence

Budget management

Program management

Ausbildung

Bachelor's degree

MBA or related advanced degree

Jobbeschreibung

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

The Executive Director, Appeals Process & Technology leads a critical function responsible for driving the coordinated effort to migrate Aetna Grievances & Appeals business processes to a modernized technology platform. This role owns the strategy and execution of a large, complex, cross‑functional program to create more efficient and consistent processes, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements.

The role requires a proven operator who can lead through complexity, influence at the executive level, and build high‑performing teams within a highly matrixed environment.

Primary Responsibilities

Product Model Business General Manager

• Partner closely with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting capabilities, and improve operational scalability.
• Define and communicate the long‑term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures.
• Provide executive guidance to ensure business requirements and outcomes are integrated into technology delivery plans.
• Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders.
• Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners.

Investment Prioritization, Management & Impact Tracking

• Lead development of business cases and establish investment priorities in partnership with A&G functional leaders, DDAT, and other stakeholders.
• Make enterprise‑level trade‑off decisions related to scope, sequencing, funding, and business value.
• Oversee program and technology spend, ensure budget discipline, and track expected business benefits and operational efficiencies.

Policies, Workflows & Training Coordination

• Lead teams in developing and updating policies, workflows, and job aids in partnership with accountable Operations teams.
• Ensure new platform functionality and business processes are reflected in consistent workflows while balancing the need to minimize system customization with plan sponsor requirements.
• Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training.

Process Assurance (Quality) Strategy & Operations

• Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and well understood.
• Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness.
• Use process assurance findings to strengthen policies, workflows, training, and operational processes.

Required Qualifications

• 15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
• Proven experience leading leaders and large‑scale, front‑line operational teams.
• Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes.
• Strong health plan operations experience; experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions is highly valued.
• Strong operational acumen, including workforce management, workflow optimization, process improvement, productivity, quality, and compliance.
• Proven ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions.
• Experience developing business cases, prioritizing investments, managing budgets, and using operational and financial data to drive decisions.
• Working knowledge of CMS, state regulatory requirements, HIPAA, privacy, and audit readiness.
• Executive presence with the ability to influence senior leaders and communicate complex information clearly and effectively.
• Bachelor’s degree or equivalent experience required; advanced degree preferred.

Pay Range

The Typical Pay Range For This Role Is $131,500.00 - $303,195.00

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.

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: 11/03/2026

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