Executive Director, Appeals Process & Technology – Aetna

CVS Health•Hartford, CT

6d•$131,500 - $303,195

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 designed to create more efficient and consistent processes, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements. It requires an experienced operator who can lead through complexity, influence at the executive level, and build high-performing teams in a highly matrixed environment. The position partners with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions; defines long-term business strategy and success measures for technology products supporting A&G teams; and provides executive guidance to integrate business requirements and outcomes into technology delivery. It leads platform migration planning and execution with DDAT and Operations leaders, while acting as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other partners. The Executive Director leads business case development and investment prioritization, makes enterprise-level decisions about scope, sequencing, funding, and business value, and oversees program and technology spending and benefit tracking. The role also leads policy, workflow, job-aid, and training coordination, and directs process assurance and quality routines to support fairness, consistency, plan sponsor expectations, regulatory compliance, and audit readiness.

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, including workforce management, workflow optimization, process improvement, productivity, quality, and compliance.
Proven 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 required.

Nice To Haves

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

Responsibilities

Partner with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, improve reporting, and increase operational scalability.
Define and communicate the long-term business strategy, outcomes, KPIs, and success measures for technology products supporting A&G teams.
Provide executive guidance to 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 partners.
Lead development of business cases and establish investment priorities with A&G functional leaders, DDAT, and other stakeholders.
Make enterprise-level trade-off decisions regarding scope, sequencing, funding, and business value.
Oversee program and technology spending, maintain budget discipline, and track expected business benefits and operational efficiencies.
Lead teams developing and updating policies, workflows, and job aids with accountable Operations teams.
Ensure platform functionality and business processes are reflected in consistent workflows while balancing limited 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 well 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.