Executive Director, Adjudication Data Services

CVS Health•Buffalo Grove, IL

1d•Hybrid

About The Position

The Executive Director oversees the Adjudication Data Services, including Member Eligibility, Member Data Transition, Drug, Pharmacy and Managed File Transfer application systems portfolio for CVS Health. This role involves working with business stakeholders, technology teams, vendors, and external partners to align technology solutions with strategic goals and objectives.

Requirements

The ideal candidate will possess a strong work ethic, demonstrate proactive initiative, and maintain high productivity in a dynamic, collaborative environment.
12+ years in Healthcare IT, including 4 years at Director+ level, leading teams in application/system architecture & development on Cloud technologies.
10+ years in client-facing support, handling production issues, cross-functional resolution, executive reporting, and SLA adherence.
Skilled at managing cross-functional issues and leading diverse teams without direct authority.
5+ years in leading and scaling support operations.
Experience in AI technologies.
Proficient in cloud engineering, designing scalable and secure cloud infrastructure.
Strategic planning for enterprise applications, focusing on growth, performance tuning, and optimization.
Analyzed enterprise platforms to identify deficiencies and recommend improvements.
Experienced in budgets, strategic planning, process enhancement, technical leadership, HR management, and staff development.
Available to travel up to 10%.

Nice To Haves

Experience in AS/400 and Mainframe related technologies
Strong knowledge and experience in IT vendor management and IT service management methodologies and frameworks.
Demonstrated leadership through transformation initiatives.
Proven experience in a product-led transformation and mature operations.
Strong people leadership capabilities with the ability to build a high-performing team through formal training, diverse assignments, coaching, mentoring, and other techniques.
Strong communication, collaboration, and stakeholder management skills, with the ability to influence and negotiate at all levels.
Strong analytical, problem-solving, and decision-making skills, with the ability to drive innovation and continuous improvement.
Experience with newer SDLC methodologies like Agile, SCRUM, and XP.
Knowledge of CMS Medicare regulations.

Responsibilities

Lead a cross-functional team of technology professionals supporting the portfolio assets and large data workloads on the IBMi series platform, Azure, and Google Cloud.
Expertise in utilizing cloud technologies to develop and implement modern data domain solutions.
Ability to analyze use cases and create innovative solutions that meet business needs.
Partner and co-lead solution engineering discipline, guiding, and mentoring talent in implementing solutions across various technology platforms.
Collaborate with stakeholders to understand business processes, challenges, and objectives, translating these into effective implementation plans.
Assess issue risks and develop mitigation strategies to minimize impact on clients.
Build and execute on the data exchanges strategy to streamline and simplify different data exchanges in PBM.
Provide strategic direction to co-develop and execute our modernization vision on ‘Adjudication as a Service’ by creating single sources of truth within domain contexts.
Innovate by adopting and implementing AI into business processes and software engineering.
Focus on strategies to reduce the cost of change, deploy automation, increase speed to market, enhance technology relevance, and ensure platform scalability and serviceability.
Establish and implement application development standards to promote the modularization of adjudication functions and the creation of domain services for consistent client and member experiences.
Manage overall delivery, ensuring quality, design, timeliness, budget adherence, and alignment with key OKRs and KPIs.
Oversee IT budget, resources, and vendors delivering IT projects and services in alignment with OKRs.
Maintain effective communication and collaboration with business stakeholders, vendors, and external partners, meeting business requirements and expectations and resolving issues or escalations.
Ensure compliance of systems and applications with company policies, standards, and regulations, identifying, assessing, and mitigating risks and controls.
Promote a culture of innovation and strategic thinking within the organization, encouraging new ideas and continuous improvement in business and technical processes.
Inspire and mobilize teams towards talent development, creating an environment that fosters the acquisition of new skills and continuous improvement.
Address challenges related to organic growth, system performance, and end-of-life software/hardware while ensuring compliance with regulatory requirements.