Associate Vice President, Adjudication Services

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.

·       Mission-critical outcomes. Be accountable for the availability, performance, accuracy and compliance of the claims processing platform that our clients, members, pharmacies and partners rely on every minute of every day.

·       One strategy across Commercial, Government and Strategic portfolios. Create a North Star vision for the adjudication services ecosystem and turn it into an executable roadmap that aligns people, process and technology

·       Transformation through Innovation. Provide hands-on impetus to the ongoing shift from existing applications to a cloud-native, microservices-based, domain-driven architecture while keeping the claims processing platform highly efficient. Drive the move from project to product, and modernize the experience layers that sit on top of established platforms.

·       Integration and interoperability. Set the direction for API first strategy, governance and lifecycle management, and for real-time and batch integration across internal platforms, clients, prescribers, networks and external partners.

·       AI and automation. Embed AI, DevSecOps, test automation and simplified architecture into how we build and run the platform, with the goal of moving the organization from reactive operations to predictive operations. We measure success by cycle time, throughput and quality, not by activity.

·       Business partnership. Partner as a peer with senior leaders across Operations, Product, Client Services, Network Management, Pricing, Data and Integration Services, and Client Experience Engineering to prioritize investments and deliver shared results.

·       Portfolio and financial stewardship. Manage a large multi-program investment portfolio and cost base, ensuring delivery that is on time, on budget and at the quality our business demands. Build business cases that fund innovation and disruption.

·       Resilience and regulatory excellence. Anticipate growth, performance and end-of-life risks before they become problems, and ensure compliance with HIPAA, NCPDP, CMS and other regulatory requirements across every program.

·       People and culture. Lead, grow and inspire a high-performing organization of exec directors, directors, managers, engineers and partners. Build a culture of innovation, accountability and continuous improvement, and develop the next generation of senior technology leaders.

·       Ecosystem and industry leadership. Partner with technology providers and third parties to accelerate innovation, and stay ahead of industry shifts, new business models and emerging technology so our platform is ready for what comes next.

·       A unified adjudication services organization with clear accountability, faster decisions and stronger alignment across Commercial, Government and Strategic priorities.

·       Reliable and resilient claims processing that sustains business continuity while the platform is transformed.

·       A focused transformation roadmap that reduces complexity, improves speed and creates reusable platform capabilities without introducing unnecessary operational risk.

·       More predictable delivery of regulatory, client and strategic commitments, with transparent measures of progress, value, quality and risk.

·       A strong leadership bench and engineering culture that can operate effectively through ambiguity, pressure and continuous change.

·       Innovation translated into practical outcomes, not technology for its own sake.

The typical pay range for this role is: