Executive Director, Claims Operations Excellence - Aetna

CVS Health•Hartford, CT

6d•$131,500 - $303,195

About The Position

The Executive Director, Claims Operational Excellence is a senior leader within Claims, responsible for improving how work gets done across the end-to-end claims lifecycle. This role focuses on simplifying processes, strengthening performance, and driving measurable improvements in accuracy, efficiency, and experience. This leader sits at the center of claims operations—partnering across Payment Integrity, Customer Operations, Plan Sponsor Services, and vendor partners—to identify breakdowns, implement solutions, and ensure changes translate into sustained operational improvement.

Requirements

10+ years of experience leading operations, process improvement, or transformation initiatives, with demonstrated business impact
Deep expertise in operational excellence, process transformation, and change leadership
Proven experience leading cross-functional initiatives from problem definition through execution
Demonstrated ability to improve end-to-end operational performance across complex, multi-step workflows
Experience leading change in established organizations, with a track record of driving adoption and improving ways of working
Experience overseeing vendor performance, including driving accountability to service levels and business outcomes
Experience leading organizations through people leaders, including building, developing, and holding teams accountable to performance outcomes
Demonstrated ability to build and scale operational or process improvement capabilities
Strong business and financial acumen, with the ability to use data to drive decisions
Executive presence with the ability to influence senior leaders and stakeholders
Bachelor’s degree or equivalent experience

Responsibilities

Lead end-to-end claims process improvement efforts across the lifecycle (intake, adjudication, payment, recovery), from problem identification through execution
Identify process breakdowns and performance gaps; implement solutions that reduce errors, rework, and cycle time
Establish consistent operating frameworks, performance metrics, and routines to sustain results over time
Drive alignment across Claims, Payment Integrity, Customer Operations, and other partners to ensure improvements are adopted and embedded
Partner with Payment Integrity to connect prevention, detection, and recovery efforts to upstream process improvements
Translate insights into changes that reduce leakage and improve accuracy at the source
Ensure tighter integration between operational workflows and integrity strategies
Simplify processes to improve provider and member experience, with a focus on transparency, ease, and resolution time
Reduce provider abrasion and member friction through targeted operational changes
Use data to understand performance drivers and prioritize improvement opportunities
Oversee vendor performance, including SLAs, service quality, and accountability to business outcomes
Strengthen governance by clarifying ownership, improving visibility, and reinforcing accountability across the organization
Lead large-scale operational improvement initiatives, ensuring changes are effectively implemented and sustained
Build and scale continuous improvement capabilities across the organization
Partner with Learning & Development to embed core skills (e.g., problem solving, Lean, data-driven decision making)
Champion a culture of accountability, continuous improvement, and innovation
Serve as a trusted partner to senior leaders, balancing strategic perspective with execution focus
Influence across a highly matrixed environment to drive alignment and results
Translate operational insights into clear, actionable recommendations