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.

Position Summary
The Executive Director, Claims & Payment Integrity Strategy will report to the VP, Claims & Payment Integrity of Aetna and serve as the central strategic integrator across the end‑to‑end claim lifecycle, accountable for aligning Claims & PI strategic plan, operational oversight, capital submissions and overall structure of the team.

This leader will partner closely with leadership to define, document, and execute the short‑, mid‑, and long‑term Claim / PI strategy, ensuring consistent alignment across claims and Payment Integrity programs, analytics, reporting, finance, procurement, and operations while maintaining current Medical Cost Spend performance.

Key Responsibilities

• 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.
  

Required Qualifications

• Approximately 10-12 years of Business Operations Oversight
• Strong knowledge of Payment Integrity and / or Claims Operations.
• Proven success doing bringing standardization and mobilization of operational discipline
• Demonstrated experience leading enterprise strategy, planning, and execution in a complex, matrixed healthcare environment.
• Strong understanding of reporting, analytics, and financial measurement.
• Proven ability to align diverse teams, stakeholders, and vendors toward a shared strategic vision.

Education

• Bachelor's degree or equivalent experience.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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