Executive Director, Appeals Process & Technology – Aetna

CVS Health•Hartford, CT

About The Position

The Executive Director, Appeals Process & Technology leads the coordinated migration of Aetna Grievances & Appeals business processes to a modernized technology platform. The role owns the strategy and execution of a large, complex, cross-functional program intended to improve efficiency and consistency, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements. The position calls for an experienced operator who can lead through complexity, influence at the executive level, and develop high-performing teams in a highly matrixed environment. The Executive Director partners with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions; defines the long-term business strategy and success measures for technology products supporting A&G teams; and ensures business outcomes inform technology delivery. In partnership with DDAT and Operations leaders, the role leads platform migration planning and execution and serves as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other partners. The position leads investment prioritization and impact tracking, including business cases, enterprise-level trade-off decisions, program and technology spending, and monitoring expected benefits and operational efficiencies. It also leads policy, workflow, job-aid, and training coordination with accountable Operations and Learning & Performance teams. The role oversees process assurance and quality routines across A&G Operations, ensuring they are independent, fair, consistent, aligned with plan sponsor and regulatory expectations, and audit-ready. Findings are used to improve policies, workflows, training, and operations.

Requirements

15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
Proven experience leading leaders and large-scale, front-line operational teams.
Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes.
Strong health plan operations experience.
Strong operational acumen in workforce management, workflow optimization, process improvement, productivity, quality, and compliance.
Ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions.
Experience developing business cases, prioritizing investments, managing budgets, and using operational and financial data to drive decisions.
Working knowledge of CMS and state regulatory requirements, HIPAA, privacy, and audit readiness.
Executive presence and ability to influence senior leaders and communicate complex information clearly and effectively.
Bachelor’s degree or equivalent experience.

Nice To Haves

Experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions.
Advanced degree.

Responsibilities

Align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting, and improve operational scalability.
Define and communicate long-term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures.
Ensure business requirements and outcomes are incorporated into technology delivery plans.
Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders.
Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners.
Develop business cases and establish investment priorities with A&G functional leaders, DDAT, and stakeholders.
Make enterprise-level trade-off decisions concerning scope, sequencing, funding, and business value.
Oversee program and technology spending, maintain budget discipline, and track expected benefits and operational efficiencies.
Lead teams developing and updating policies, workflows, and job aids in partnership with accountable Operations teams.
Ensure platform functionality and business processes are reflected in consistent workflows while balancing system customization with plan sponsor requirements.
Champion continuous process improvement and coordinate training with Learning & Performance and Operations teams.
Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and understood.
Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness.
Use process assurance findings to strengthen policies, workflows, training, and operational processes.