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
A Brief Overview The Lead Director Payment Integrity Escalations and Rework oversees the implementation of the process improvement strategy as it pertains to Payment Integrity and its impact on re-work and responsible for creating a Payment Integrity Escalations process that aligns with the broader Service Operations Escalation process. This leader will leads teams in the identification and resolution of process issues, re-work initiatives and serves as the main point of contact/liaison for internal and external customers as it pertains to Payment Integrity Escalations.
What you will do
o Communicates with top management on the dynamics of the end-to-end processes and uncovers opportunities related to Payment Integrity & Re-work resolution
o Communicates strategically across business units to understand business priorities, goals, and success measures.
o Contributes to business objectives and develops documentation for business process requirements that support department needs for creating and executing on an escalation process / pathway.
o Contributes to top-level decision making on process design to enhance productivity and ensure clarity in process execution.
o Responsible for understanding Payment Integrity claim lifecycle to help leaders examine workflows and systems to identify bottlenecks and inefficiencies.
o Designs (or participates in design) performance indicators to enable data-driven decision making around escalations and re-work.
o Determines potential process improvements based on department needs; considers technology solutions to streamline new processes.
o Develops risk management processes to identify potential risks and ensure adherence to legal and regulatory compliances
o Develops a cross-functional high performing team of department heads, experts, and external partners to align processes across different functions to achieve organizational objectives.
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.
Required Qualifications
- 10+ years work experience in standing up new products / processes
- 5 years of experience in claims re-work
- 10 years of experience of escalation management / oversight
- 5+ years experience in working with healthcare providers
Preferred Qualifications
Comfortable working in high pressure environments
Education
- Bachelor's degree preferred/specialized training/relevant professional qualification.
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.
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.
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
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Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
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Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
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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.
