Executive Director, Claims & Payment Integrity Strategy

CVS Health•Hartford, CT

1d•$131,500 - $303,195

About The Position

The Executive Director, Claims & Payment Integrity Strategy reports to the VP, Claims & Payment Integrity of Aetna and serves as the central strategic integrator across the end-to-end claim lifecycle. The role is accountable for aligning the Claims & Payment Integrity strategic plan, operational oversight, capital submissions, and overall team structure. The leader partners with leadership to define, document, and execute short-, mid-, and long-term claims and Payment Integrity strategy. They align claims and Payment Integrity programs with analytics, reporting, finance, procurement, and operations while maintaining current Medical Cost Spend performance.

Requirements

Approximately 10–12 years of business operations oversight experience.
Strong knowledge of Payment Integrity and/or claims operations.
Proven success bringing standardization and operational discipline to operations.
Demonstrated experience leading enterprise strategy, planning, and execution in a complex, matrixed healthcare environment.
Strong understanding of reporting, analytics, and financial measurement.
Proven ability to align diverse teams, stakeholders, and vendors toward a shared strategic vision.
Bachelor's degree or equivalent experience.

Responsibilities

Partner with Claims & Payment Integrity leadership to develop and execute enterprise strategy across 12-month, 3-year, and 5-year-plus horizons.
Establish an end-to-end CPI operating model integrating people, processes, technology, and vendor capabilities across the claim lifecycle.
Coordinate strategically across initiatives that combine multiple CPI teams and capabilities.
Document and maintain a CPI strategic roadmap and align stakeholders across DDAT, ACS, Reporting, Finance, Procurement, Operations, and other groups.
Create and manage governance forums, operating cadences, and decision frameworks that align workstreams while balancing transformation with day-to-day operational performance.
Communicate internal and external environmental impacts affecting CPI strategy, the vendor landscape, and regulatory considerations.
Position Payment Integrity programs to pay claims once and correctly, maximizing financial and operational value across the lifecycle.
Partner with reporting and analytics teams to define enterprise CPI reporting standards, dashboards, and insights that demonstrate value, savings, recoveries, and operational effectiveness.
Establish and monitor KPIs tied to the strategic plan, including CPI value creation, vendor efficiency, insourcing progress, and financial outcomes.
Lead efforts to insource capabilities from external vendors, reduce vendor spend, and improve return on investment across the CPI portfolio.
Partner with Finance and Procurement to align vendor strategies with long-term Payment Integrity goals, financial targets, and operational scalability.
Integrate and align multiple Payment Integrity teams into a streamlined, end-to-end operating model.
Establish and drive adoption of enterprise KPIs that track performance against strategic objectives.