Executive Director, Adjudication Data Services

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. Position Summary The Executive Director oversees the Adjudication Data Services, including Member Eligibility, Member Data Transition, Drug, Pharmacy and Managed File Transfer application systems portfolio for CVS Health. This role involves working with business stakeholders, technology teams, vendors, and external partners to align technology solutions with strategic goals and objectives. Key Responsibilities Lead a cross‑functional team of technology professionals supporting the portfolio assets and large data workloads on the IBMi series platform, Azure, and Google Cloud. Expertise in utilizing cloud technologies to develop and implement modern data domain solutions. Ability to 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 the modularization of adjudication functions and the creation of domain services for consistent client and member experiences. 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 towards 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. Skilled at managing cross‑functional issues and leading diverse teams without direct authority. 5+ years in leading and scaling support operations. Experience in AI technologies. Proficient in cloud engineering, designing scalable and secure cloud infrastructure. Strategic planning for enterprise applications, focusing on growth, performance tuning, and optimization. Analyzed enterprise platforms to identify deficiencies and recommend improvements. Experienced in budgets, strategic planning, process enhancement, technical leadership, HR management, and staff development. Available to 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 a 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, with the ability to influence and negotiate at all levels. Strong analytical, problem‑solving, and decision‑making skills, with the ability to drive 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 This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 05/29/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement