Lead Director, Claim Management – Provider Digital Operations

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 Lead Director, Claim Management for Provider Digital Operations is responsible for the strategic leadership and operational oversight of Aetna’s Claim suite of provider-facing transactions – inclusive of Claim Submission, Status, Attachments, and Remittances. This role partners with the technology teams to develop strategy and roadmaps, ensuring exceptional provider experiences and operational excellence through performance management, compliance, and team leadership. This role is critical to driving improvements in provider experience, reducing rework, calls, and paperwork, and improving key metrics such as NPS. The Lead Director will be accountable for end-to-end thinking, cross-team collaboration, and resource alignment to deliver innovative solutions that enhance provider and colleague experiences.

Key Responsibilities

Strategic Leadership

• Develop and execute comprehensive transaction strategies and roadmaps aligned with prioritized provider experience initiatives and workflow requirements.
• Collaborate with senior management to define strategic objectives and investment priorities for transaction  enhancements.

Operational Excellence

• Oversee transaction performance, defect resolution, and be involved with incident response coordination.
• Lead cross-functional teams to deliver projects and programs from initiation through completion, ensuring timely delivery within budget and scope.
• Participate in monthly and quarterly health checks and business reviews with vendors.

Compliance & Risk Management

• Ensure ongoing compliance through annual security risk assessments, user entitlement validation, recertification, business continuity planning, and process documentation.
• Coordinate responses to compliance incidents, including potential PHI breaches and audits.

Project & Program Management

• Identify project stakeholders, establish effective communication channels, and manage expectations.
• Monitor expenditures and ensure adherence to financial constraints throughout the project lifecycle.
• Prepare and present progress reports to stakeholders and senior management.
• Develop and implement mitigation strategies to minimize risks and ensure project success.
• Identify opportunities for process improvement and implement best practices, lessons learned, and industry standards.

Team Leadership

• Provide leadership and guidance to project and program teams, assigning responsibilities, setting performance expectations, and motivating team members to achieve objectives.
• Perform strong performance monitoring and evaluation; offer specific feedback

Minimum Requirements

• 10+ years of healthcare experience, preferably working with network and provider-related operations and strategy.
• 5+ years leading and developing high-functioning teams.
• Adept at execution and delivery (planning, delivering, and supporting).
• Strong business intelligence, collaboration, and teamwork skills.
• Mastery of problem-solving and decision-making.
• Demonstrated growth mindset (agility and developing yourself and others).
• Bachelor’s degree preferred; specialized training or relevant professional qualification considered.

Preferred Qualifications

• Experience with digital transactions and/or self-service capabilities.

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification.

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.