Executive Director, Appeals Process & Technology – 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.

The Executive Director, Appeals Process & Technology leads a critical function responsible for driving the coordinated effort to migrate Aetna Grievances & Appeals business processes to a modernized technology platform. This role owns the strategy and execution of a large, complex, cross-functional program to create more efficient and consistent processes, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements.

The role requires a proven operator who can lead through complexity, influence at the executive level, and build high-performing teams within a highly matrixed environment.

• Partner closely with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting capabilities, and improve operational scalability.
• Define and communicate the long-term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures.
• Provide executive guidance to ensure business requirements and outcomes are integrated into technology delivery plans.
• Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders.
• Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners.

• Lead development of business cases and establish investment priorities in partnership with A&G functional leaders, DDAT, and other stakeholders.
• Make enterprise-level trade-off decisions related to scope, sequencing, funding, and business value.
• Oversee program and technology spend, ensure budget discipline, and track expected business benefits and operational efficiencies.

• Lead teams in developing and updating policies, workflows, and job aids in partnership with accountable Operations teams.
• Ensure new platform functionality and business processes are reflected in consistent workflows while balancing the need to minimize system customization with plan sponsor requirements.
• Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training.

• Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and well understood.
• Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness.
• Use process assurance findings to strengthen policies, workflows, training, and operational processes.

• 15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
• Proven experience leading leaders and large-scale, front-line operational teams.
• Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes.
• Strong health plan operations experience; experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions is highly valued.
• Strong operational acumen, including workforce management, workflow optimization, process improvement, productivity, quality, and compliance.
• Proven ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions.
• Experience developing business cases, prioritizing investments, managing budgets, and using operational and financial data to drive decisions.
• Working knowledge of CMS, state regulatory requirements, HIPAA, privacy, and audit readiness.
• Executive presence with the ability to influence senior leaders and communicate complex information clearly and effectively.
• Bachelor’s degree or equivalent experience required; advanced degree preferred.

The typical pay range for this role is: