Lead Director, Appeals and Grievances

CVS Health•Work At Home-Connecticut, CT

4d•$100,000 - $231,540

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Administers project and process management initiatives, overseeing their execution and ensuring adherence to established standards and guidelines. Advises the general manager and senior leadership on project and process management strategies, providing insights and recommendations to drive organizational success. Aligns project and process management activities with the organization's overall business objectives and strategic direction. Approves project plans, budgets, and resource allocations, ensuring their alignment with project objectives and organizational priorities. Communicates strategically across the organization, fostering effective collaboration and alignment between project teams, stakeholders, and top management. Contributes to top-level decision making by providing project and process management expertise and insights, supporting the achievement of strategic goals. Controls all project and process management systems, resources, and activities, ensuring efficient and effective project delivery and process optimization. Counsels project teams and stakeholders, offering guidance and support to overcome challenges and achieve project goals. Defines programs and methodologies for project and process management, establishing best practices and frameworks to enhance project performance and efficiency. The Lead Director will be responsible for leading a team of analysts dedicated north star initiatives focusing on reducing overturns. This role will leverage data-driven insights to inform strategic decision-making and drive continuous improvement initiatives. The ideal candidate will possess strong analytical skills, a deep understanding of appeals and claims, and the ability to communicate effectively to stakeholders at all levels.

Requirements

Bachelor’s degree
5+ years of experience in appeals and claims operations, data analysis, or a related field, with at least 5 years in a leadership role.
5+ years in Project or program management
Proven track record of managing teams and driving continuous improvement initiatives in a complex, matrixed organization.
Strong analytical and problem-solving skills, with the ability to interpret and present complex data.
Excellent communication and interpersonal skills, with the ability to influence and engage stakeholders at all levels.
Proficiency in data analysis tools and software (e.g., SQL, Tableau, Power BI, Excel).
High emotional intelligence and the ability to build trust-based relationships.
Strong bias for action and results-oriented mindset.
Ability to navigate ambiguity and balance competing priorities effectively.

Nice To Haves

Experience in the healthcare, insurance, or financial services industries.
Knowledge of quality improvement methodologies (e.g., Six Sigma, Lean) and their application in root cause analysis.

Responsibilities

Administers project and process management initiatives, overseeing their execution and ensuring adherence to established standards and guidelines.
Advises the general manager and senior leadership on project and process management strategies, providing insights and recommendations to drive organizational success.
Aligns project and process management activities with the organization's overall business objectives and strategic direction.
Approves project plans, budgets, and resource allocations, ensuring their alignment with project objectives and organizational priorities.
Communicates strategically across the organization, fostering effective collaboration and alignment between project teams, stakeholders, and top management.
Contributes to top-level decision making by providing project and process management expertise and insights, supporting the achievement of strategic goals.
Controls all project and process management systems, resources, and activities, ensuring efficient and effective project delivery and process optimization.
Counsels project teams and stakeholders, offering guidance and support to overcome challenges and achieve project goals.
Defines programs and methodologies for project and process management, establishing best practices and frameworks to enhance project performance and efficiency.
Leading a team of analysts dedicated north star initiatives focusing on reducing overturns.
Leveraging data-driven insights to inform strategic decision-making and drive continuous improvement initiatives.
Collaborate with data analysts to ensure the accurate collection and analysis of relevant data to support root cause investigations.
Develop and present comprehensive reports and dashboards that summarize findings, insights, and recommendations for stakeholders.
Partner with various departments (e.g., operations, finance, clinical) to identify areas for improvement and ensure alignment with organizational goals.
Facilitate cross-functional workshops and meetings to discuss findings and collaboratively develop action plans.
Lead initiatives aimed at addressing identified root causes, implementing solutions that enhance operational efficiency and effectiveness.
Monitor the impact of implemented solutions and adjust strategies as necessary to achieve desired outcomes.