Lead Director, Claim Management – Provider Digital Operations

CVS Health•New York, NY

4d•$100,000 - $231,540

About The Position

The Lead Director, Claim Management for Provider Digital Operations is responsible for the strategic leadership and operational oversight of Aetna’s Claim suite of provider-facing transactions – inclusive of Claim Submission, Status, Attachments, and Remittances. This role partners with the technology teams to develop strategy and roadmaps, ensuring exceptional provider experiences and operational excellence through performance management, compliance, and team leadership. This role is critical to driving improvements in provider experience, reducing rework, calls, and paperwork, and improving key metrics such as NPS. The Lead Director will be accountable for end-to-end thinking, cross-team collaboration, and resource alignment to deliver innovative solutions that enhance provider and colleague experiences.

Requirements

10+ years of healthcare experience, preferably working with network and provider-related operations and strategy.
5+ years leading and developing high-functioning teams.
Adept at execution and delivery (planning, delivering, and supporting).
Strong business intelligence, collaboration, and teamwork skills.
Mastery of problem-solving and decision-making.
Demonstrated growth mindset (agility and developing yourself and others).
Bachelor’s degree preferred; specialized training or relevant professional qualification considered.

Nice To Haves

Experience with digital transactions and/or self-service capabilities.

Responsibilities

Develop and execute comprehensive transaction strategies and roadmaps aligned with prioritized provider experience initiatives and workflow requirements.
Collaborate with senior management to define strategic objectives and investment priorities for transaction enhancements.
Oversee transaction performance, defect resolution, and be involved with incident response coordination.
Lead cross-functional teams to deliver projects and programs from initiation through completion, ensuring timely delivery within budget and scope.
Participate in monthly and quarterly health checks and business reviews with vendors.
Ensure ongoing compliance through annual security risk assessments, user entitlement validation, recertification, business continuity planning, and process documentation.
Coordinate responses to compliance incidents, including potential PHI breaches and audits.
Identify project stakeholders, establish effective communication channels, and manage expectations.
Monitor expenditures and ensure adherence to financial constraints throughout the project lifecycle.
Prepare and present progress reports to stakeholders and senior management.
Develop and implement mitigation strategies to minimize risks and ensure project success.
Identify opportunities for process improvement and implement best practices, lessons learned, and industry standards.
Provide leadership and guidance to project and program teams, assigning responsibilities, setting performance expectations, and motivating team members to achieve objectives.
Perform strong performance monitoring and evaluation; offer specific feedback.