Executive Director, Adjudication Software Engineering & Transformation

Position Summary Are you interested in joining Fortune 6 CVS Health as part of our dynamic Information Technology team? If you are seeking a leadership opportunity where you can truly have influence and are enthusiastic about doing what’s right, we invite you to consider the role of Executive Director, Adjudication Software Engineering & Transformation, where you will lead software engineering and transformation of adjudication ecosystem spanning Eligibility, Member Data Transition, Drug and Pharmacy domains, and Managed File Transfer. Key Responsibilities Lead and scale a high‑performing software engineering organization responsible for applications across eligibility, member, drug, pharmacy and integration services, spanning both cloud (Azure, GCP) and legacy platforms (IBMi, Mainframe). Utilize cloud technologies to develop and implement modern data domain solutions. Analyze use cases and create innovative solutions that meet business needs. Partner and co‑lead solution engineering discipline, guiding and mentoring talent in implementing solutions across various technology platforms. Collaborate with stakeholders to understand business processes, challenges, and objectives, translating these into effective implementation plans. Assess issue risks and develop mitigation strategies to minimize impact on clients. Build and execute on the data exchanges strategy to streamline and simplify different data exchanges in PBM. Provide strategic direction to co‑develop and execute our modernization vision on “Adjudication as a Service” by creating single sources of truth within domain contexts. Innovate by adopting and implementing AI into business processes and software engineering. Focus on strategies to reduce the cost of change, deploy automation, increase speed to market, enhance technology relevance, and ensure platform scalability and serviceability. Establish and implement application development standards to promote modularization of adjudication functions and the creation of domain services for a consistent client and member experience. Manage overall delivery, ensuring quality, design, timeliness, budget adherence, and alignment with key OKRs and KPIs. Oversee IT budget, resources, and vendors delivering IT projects and services in alignment with OKRs. Maintain effective communication and collaboration with business stakeholders, vendors, and external partners, meeting business requirements and expectations and resolving issues or escalations. Ensure compliance of systems and applications with company policies, standards, and regulations, identifying, assessing, and mitigating risks and controls. Promote a culture of innovation and strategic thinking within the organization, encouraging new ideas and continuous improvement in business and technical processes. Inspire and mobilize teams toward talent development, creating an environment that fosters the acquisition of new skills and continuous improvement. Address challenges related to organic growth, system performance, and end‑of‑life software/hardware while ensuring compliance with regulatory requirements. Required Qualifications 12+ years in Healthcare IT, including 4+ years at director‑level, leading teams in application/system architecture & development on cloud technologies. 10+ years in client‑facing support, handling production issues, cross‑functional resolution, executive reporting, and SLA adherence. Proficient at managing cross‑functional issues and leading diverse teams without direct authority. 5+ years leading and scaling support operations. Experience in AI technologies. Proficient in cloud engineering and designing scalable, secure cloud infrastructure. Strategic planning for enterprise applications, focusing on growth, performance tuning, and optimization. Analyzed enterprise platforms, identified deficiencies, and recommended improvements. Experienced in budgets, strategic planning, process enhancement, technical leadership, HR management, and staff development. Travel up to 10%. Preferred Qualifications Experience in AS/400 and Mainframe related technologies. Strong knowledge and experience in IT vendor management and IT service management methodologies and frameworks. Demonstrated leadership through transformation initiatives. Proven experience in product‑led transformation and mature operations. Strong people leadership capabilities with the ability to build a high‑performing team through formal training, diverse assignments, coaching, mentoring, and other techniques. Strong communication, collaboration, and stakeholder management skills, influencing and negotiating at all levels. Strong analytical, problem‑solving, and decision‑making skills, driving innovation and continuous improvement. Experience with newer SDLC methodologies like Agile, SCRUM, and XP. Knowledge of CMS Medicare regulations. Education Bachelor’s degree in computer science, information systems, or related field, or equivalent work experience. Pay Range The typical pay range for this role is: $175,100.00 – $334,750.00. The actual base salary offered will depend on experience, education, geography, and other factors. Benefits This full‑time position is eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Equal Opportunity Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr