Executive Director, Claims & Payment Integrity Strategy

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.

• →Partner with Claims & Payment Integrity (CPI)  leadership to develop and execute the enterprise strategy across 12‑month, 3‑year, and 5‑year+ horizons.
• →Establish a cohesive end‑to‑end CPI operating model that integrates people, process, technology, and vendor capabilities across the full claim lifecycle.
• →Serve as the single point of strategic coordination for initiatives combining multiple CPI teams and capabilities.
• →Document and maintain a clear CPI strategic roadmap, ensuring cross‑functional alignment across DDAT, ACS, Reporting, Finance, Procurement, Operations, and other stakeholders.
• →Create and manage governance forums, operating cadences, and decision frameworks to keep workstreams aligned while balancing transformation with day‑to‑day operational performance.
• →Communicate internal and external environmental impacts affecting CPI strategy, vendor landscape, and regulatory considerations.
• →Ensure PI programs are positioned to pay claims once and pay them correctly, maximizing financial and operational value across the lifecycle.
• →Partner with reporting and analytics teams to define enterprise CPI reporting standards, dashboards, and insights that clearly demonstrate value, savings, recoveries, and operational effectiveness.
• →Establish and monitor key performance indicators (KPIs) tied to the strategic plan, including CPI value creation, vendor efficiency, insourcing progress, and financial outcomes.
• →Lead strategic efforts to insource capabilities from external vendors, reduce vendor spend, and improve return on investment across the CPI portfolio.
• →Partner with Finance and Procurement to ensure vendor strategies align with long‑term PI goals, financial targets, and operational scalability.
• →Successful integration and alignment of multiple Payment Integrity teams into a streamlined, end‑to‑end operating model.
• →Establishment and adoption of enterprise KPIs that track performance against strategic objectives.
  

• Bachelor's degree or equivalent experience.

The typical pay range for this role is: