Executive Director, Claims Operations Excellence - Aetna

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, Claims Operational Excellence is a senior leader within Claims, responsible for improving how work gets done across the end-to-end claims lifecycle. This role focuses on simplifying processes, strengthening performance, and driving measurable improvements in accuracy, efficiency, and experience.

This leader sits at the center of claims operations—partnering across Payment Integrity, Customer Operations, Plan Sponsor Services, and vendor partners—to identify breakdowns, implement solutions, and ensure changes translate into sustained operational improvement.

Key Responsibilities

Operational Excellence Leadership

• Lead end-to-end claims process improvement efforts across the lifecycle (intake, adjudication, payment, recovery), from problem identification through execution

• Identify process breakdowns and performance gaps; implement solutions that reduce errors, rework, and cycle time

• Establish consistent operating frameworks, performance metrics, and routines to sustain results over time

• Drive alignment across Claims, Payment Integrity, Customer Operations, and other partners to ensure improvements are adopted and embedded

Payment Integrity & Process Integration

• Partner with Payment Integrity to connect prevention, detection, and recovery efforts to upstream process improvements

• Translate insights into changes that reduce leakage and improve accuracy at the source

• Ensure tighter integration between operational workflows and integrity strategies

Experience & Performance Improvement

• Simplify processes to improve provider and member experience, with a focus on transparency, ease, and resolution time

• Reduce provider abrasion and member friction through targeted operational changes

• Use data to understand performance drivers and prioritize improvement opportunities

Vendor & Governance Oversight

• Oversee vendor performance, including SLAs, service quality, and accountability to business outcomes

• Strengthen governance by clarifying ownership, improving visibility, and reinforcing accountability across the organization

Transformation & Capability Build

• Lead large-scale operational improvement initiatives, ensuring changes are effectively implemented and sustained

• Build and scale continuous improvement capabilities across the organization

• Partner with Learning & Development to embed core skills (e.g., problem solving, Lean, data-driven decision making)

• Champion a culture of accountability, continuous improvement, and innovation

Leadership & Influence

• Serve as a trusted partner to senior leaders, balancing strategic perspective with execution focus

• Influence across a highly matrixed environment to drive alignment and results

• Translate operational insights into clear, actionable recommendations

Required Qualifications

• 10+ years of experience leading operations, process improvement, or transformation initiatives, with demonstrated business impact

• Deep expertise in operational excellence, process transformation, and change leadership

• Proven experience leading cross-functional initiatives from problem definition through execution

• Demonstrated ability to improve end-to-end operational performance across complex, multi-step workflows

• Experience leading change in established organizations, with a track record of driving adoption and improving ways of working

• Experience overseeing vendor performance, including driving accountability to service levels and business outcomes

• Experience leading organizations through people leaders, including building, developing, and holding teams accountable to performance outcomes

• Demonstrated ability to build and scale operational or process improvement capabilities

• Strong business and financial acumen, with the ability to use data to drive decisions

• Executive presence with the ability to influence senior leaders and stakeholders

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