Executive Director, Adjudication Strategic & Commercial Engineering

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

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.

Qualifications: The candidate will have a strong work ethic, be an initiative-taker, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

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