Executive Director, Claims Ops - Medicaid & Duals

4062 Aetna Resources, LLC; Hartford (CT); Sur place; USD 132 000 - 303 000; Plein temps

Avantages offerts par ce poste

Bonus program

Equity awards

Comprehensive benefits

Résumé du poste

CVS Health is seeking an Executive Director of Claims Service Operations to lead Medicaid and Duals across multiple markets. You will drive operational excellence, automate adjudication, and work with health plan leaders to align priorities and achieve strong performance.

The role requires strategic vision, executive communication, and the ability to manage vendor relationships in a complex, matrixed environment.

Qualifications

• 12+ years of healthcare operations, managed care, claims, or health plan experience.
• 2+ years leading direct / indirect employees and developing teams (100+)
• Strong knowledge of Medicaid, and/or Duals will be highly valued
• Proven ability to influence and collaborate across a highly matrixed organization.
• Innovative mind‑set and willingness to challenge the status quo
• Proven track record leading large-scale operations across multi-site, remote, and vendor‑supported environments
• Experience partnering effectively across operations, technology, compliance, finance, clinical, provider, and health plan organizations
• Strong executive communication, change leadership, and problem‑solving skills

Responsabilités

• Lead a large, multi-market claims operations organization supporting Medicaid and Duals business performance.
• Drive operational excellence across claims inventory, timeliness, quality, payment accuracy, productivity, and service level commitments.
• Partner with health plan leaders and enterprise stakeholders to align priorities, resolve operational challenges, and execute strategic initiatives.
• Establish governance routines that connect operational performance, risk management, issue resolution, and accountability for results.
• Advance automation and auto-adjudication strategies to improve cycle times, reduce manual intervention, and increase processing accuracy.
• Partner closely with technology teams to prioritize operational enhancements, improve system performance, and support business-driven transformation initiatives.
• Support AI-enabled operational capabilities by identifying high-value use cases, defining business requirements, and improving quality and productivity outcomes.
• Develop workforce and capacity strategies, including staffing models, resource planning, budgeting, and vendor optimization.
• Lead vendor governance through performance scorecards, quality oversight, forecasting, compliance controls, and operational accountability.
• Drive continuous improvement initiatives that reduce cost, minimize rework, improve scalability, and strengthen end-to-end claims performance.
• Build and develop high-performing teams while fostering a culture of accountability, collaboration, innovation, and execution.

Connaissances

Executive leadership

Change leadership

Operational excellence

Strategic collaboration

Problem solving

Formation

Bachelor's degree or equivalent experience

Outils

QNXT

Description du poste

CVS Health is seeking an Executive Director of Claims Service Operations to lead Medicaid and Duals across multiple markets. You will drive operational excellence, automate adjudication, and work with health plan leaders to align priorities and achieve strong performance.

The role requires strategic vision, executive communication, and the ability to manage vendor relationships in a complex, matrixed environment.