Lead Director – Payment Integrity Operational Execution and Strategy

Posted 3 Days Ago
Be an Early Applicant
22 Locations
In-Office or Remote
100K-232K Annually
Expert/Leader
Fitness • Healthtech • Retail • Pharmaceutical
The Role
Lead a business strategy team to define and execute Payment Integrity strategy and programs. Drive cross-functional collaboration, strategic planning, program delivery, change management, executive reporting, budget planning, and stakeholder engagement to improve operational efficiency and business outcomes.
Summary Generated by Built In

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.

Overview:

Leads and oversees the business strategy team by setting strategic objectives and driving the organization's overall business strategy. Collaborates with senior leadership to develop long-term plans and align business strategies with the company's vision and mission. Conducts performance evaluations, mentor team members, and provides guidance on strategic analysis and planning. Evaluates new business opportunities, fosters innovation, and adapts strategies to meet evolving market conditions and industry trends.

Description of activities:

  • Drive successful execution of strategic initiatives and programs within the organization.
  • Collaborate with business and Cross Matrixed partners to enhance the Payment Integrity strategy and roadmap; translate and simplify ambiguous problems into frameworks which inform solutions to drive short and long-term business strategies
  • Advises general managers on strategic alignment tools, program management methodologies for risk management and change control processes to ensure cohesiveness in departmental operations and processes.
  • Identifies and capitalizes on potential business opportunities, partnerships, and collaborations that align with the organization's strategic objectives.
  • Creates executive-ready reporting / measurement of program outcomes, business impacts, and lessons learned through documentation to inform future program planning efforts.
  • Explores opportunities for interoperability, process optimization, and the adoption of new technologies to enhance operational efficiency and patient outcomes.
  • Contributes to planning budgets for strategic initiatives and programs that drive organizational growth, operational effectiveness, and innovation.
  • Contributes to top-level decision-making surrounding program execution and progress to ensure that program objectives are achieved within the defined timeframes and budgets.
  • Leads and facilitates change initiatives that arise from strategic programs and communicates changes to stakeholders while managing resistance and ensuring smooth transitions.
  • Develop and maintain relationships with wide range of stakeholders including business partners, HealthPlan leaders, other data and analytic teams, Legal, etc.

Required Qualifications

  • 10-15 years work experience
  • 10+ years problem mastery level Problem Solving  and decision making skills.
  • Proven track record of execution and delivery (planning, delivering, and supporting)
  • Strategy experience. 4+ years' experience strategy consulting or on strategy teams in large companies (complex problem solving and stakeholder management)
  • Strong written and oral communication skills including delivering structured presentations to executive leadership
  • Advanced Microsoft Powerpoint and Excel experience
  • Comfort in ambiguity and ability to simplify complex problems

Preferred Qualifications

  • Solid understanding and hands-on experience working with  Payment Integrity Operations
  • Business Case development, Capital planning and demonstrated value realization/calculation post deployment/action outcome.

Education

Bachelor's degree in Business Analytics, Economics, Finance, Statistics, a quantitative field, or equivalent practical experience required

**We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy.  Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00


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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


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

We anticipate the application window for this opening will close on: 08/22/2026

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

Skills Required

  • 10-15 years work experience
  • 10+ years problem-solving and decision-making mastery
  • Proven track record of execution and delivery (planning, delivering, and supporting)
  • 4+ years strategy consulting or strategy team experience in large companies
  • Strong written and oral communication skills, including delivering structured presentations to executive leadership
  • Advanced Microsoft PowerPoint and Excel experience
  • Comfort in ambiguity and ability to simplify complex problems
  • Bachelor's degree in Business Analytics, Economics, Finance, Statistics, a quantitative field, or equivalent practical experience
  • Solid understanding and hands-on experience working with Payment Integrity Operations
  • Business case development, capital planning and demonstrated value realization / calculation post deployment
Am I A Good Fit?
beta
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.

The Company
HQ: Woonsocket, RI
119,959 Employees
Year Founded: 1963

What We Do

CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.

Similar Jobs

Coursera + Udemy  Logo Coursera + Udemy

Principal Product Manager

Artificial Intelligence • Consumer Web • Edtech • Enterprise Web • HR Tech • Social Impact • Generative AI
Remote or Hybrid
United States
1500 Employees
219K-274K Annually

Mondelēz International Logo Mondelēz International

Product Owner

Big Data • Food • Hardware • Machine Learning • Retail • Automation • Manufacturing
Remote or Hybrid
United States
90000 Employees
140K-193K Annually
Remote
United States
40 Employees
75K-125K Annually

Coursera + Udemy  Logo Coursera + Udemy

Senior Category Growth Manager

Artificial Intelligence • Consumer Web • Edtech • Enterprise Web • HR Tech • Social Impact • Generative AI
Remote or Hybrid
United States
1500 Employees
137K-174K Annually

Similar Companies Hiring

Scotch Thumbnail
Artificial Intelligence • eCommerce • Fintech • Payments • Retail • Software • Analytics
US
35 Employees
OneImaging Thumbnail
Healthtech
Miami, FL
62 Employees
Golden Pet Brands Thumbnail
Digital Media • eCommerce • Information Technology • Marketing Tech • Pet • Retail • Social Media
El Segundo, California
178 Employees

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account