AVP, Claims Transformation

CVS Health•Hartford, CT

7d•Hybrid

About The Position

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 AVP, Claim Transformation is responsible for reimagining, modernizing, and scaling Claim to meet evolving business, regulatory, and customer expectations. This role provides strategic leadership and enterprise direction to a complex, multi-layered organization of managers and supervisors, with a mandate to drive step-change improvement in operating models, performance, cost structure, and service experience. A core focus of the role is operational transformation—leveraging data, analytics, automation, and digital enablement to improve productivity, quality, and compliance while enhancing patient and member experiences. The AVP establishes and governs key performance indicators (KPIs), using insights to proactively identify risk, remove structural barriers, and accelerate operational maturity. The role champions service excellence by designing and implementing initiatives that prioritize patient and/or member satisfaction and improve the overall customer experience. In partnership with Quality and Compliance teams, the AVP contributes to the development and oversight of quality assurance programs that ensure adherence to healthcare regulations, accreditation standards, and internal controls. The AVP collaborates extensively across the enterprise—including Clinical, Finance, Marketing, Technology, and Human Resources—to align Service Operations strategy with broader business objectives. This role also oversees relationships with external vendors and service partners, ensuring performance against service level agreements and contribution to overall operational success. As a senior people leader, the AVP builds and sustains a high-performance, change-ready organization by developing leaders, strengthening succession pipelines, and fostering a culture of ownership, learning, and continuous improvement. The role requires the ability to lead through complexity, inspire commitment to change, and translate strategy into execution across large, distributed teams.

Requirements

12+ years of progressive leadership experience in Claims, Service Operations, or a similarly complex, regulated operational environment within healthcare or insurance.
Recognized senior people leader with a strong record of developing high performing teams, building succession pipelines, and fostering a change‑ready culture.
Proven success leading large, multi-layered organizations, delivering measurable improvements in cost, productivity, quality, and service experience.
Familiar with claims systems QXNT, ACAS or HRP.
Familiarization with CMS and State regulations.
Deep expertise in end‑to‑end claims operations, with strong understanding of operating models, performance drivers, and risk points across complex workflows.
Proven experience impacting claims timeliness, rework volumes, inventory management, performance guarantees, quality performance.
Demonstrated ability to leverage data, analytics, automation, and digital enablement to drive step‑change improvements in operational efficiency, accuracy, and compliance.
Strong performance management and governance capability, including establishing KPIs, using insights to proactively identify risk, and driving sustained operational maturity.
Experience operating in highly regulated environments, with a track record of partnering effectively with Quality, Compliance, and Audit to ensure adherence to regulatory and accreditation standards.
Highly effective cross‑enterprise collaborator, with demonstrated ability to align Service Operations strategy with Technology, Finance, Clinical, HR, and Offshore and Domestic vendor partners.
Demonstrated mastery of systems thinking, problem solving, and strategic decision making.
Growth-oriented leadership mindset with a strong track record of building leadership capability and organizational resilience.
Bachelors degree or equivalent.

Nice To Haves

Champion of AI

Responsibilities

Reimagining, modernizing, and scaling Claim to meet evolving business, regulatory, and customer expectations.
Providing strategic leadership and enterprise direction to a complex, multi-layered organization of managers and supervisors.
Driving step-change improvement in operating models, performance, cost structure, and service experience.
Leveraging data, analytics, automation, and digital enablement to improve productivity, quality, and compliance while enhancing patient and member experiences.
Establishing and governing key performance indicators (KPIs), using insights to proactively identify risk, remove structural barriers, and accelerate operational maturity.
Championing service excellence by designing and implementing initiatives that prioritize patient and/or member satisfaction and improve the overall customer experience.
Contributing to the development and oversight of quality assurance programs in partnership with Quality and Compliance teams.
Collaborating extensively across the enterprise—including Clinical, Finance, Marketing, Technology, and Human Resources—to align Service Operations strategy with broader business objectives.
Overseeing relationships with external vendors and service partners, ensuring performance against service level agreements and contribution to overall operational success.
Building and sustaining a high-performance, change-ready organization by developing leaders, strengthening succession pipelines, and fostering a culture of ownership, learning, and continuous improvement.
Leading through complexity, inspiring commitment to change, and translating strategy into execution across large, distributed teams.