CVS Health

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at CVS Health

Posted: 7/30/2020
Job Reference #: 1298474BR

Job Description

Job Description
Position Summary - Vice President Adjudication Services

The Vice President of Adjudication Services is responsible for CVS Caremark’s pharmacy claims adjudication (RxClaim) and eligibility systems supporting over 130 million members. Leads the product strategy, enhancements, day to day operations and new product development. Provide leadership to over 500 employees and contractors located throughout the US and offshore.
* Engage multiple senior business leaders to determine business/IT roadmaps for complex solutions. Primary relationships are with business leaders within PBM Client Services, Sales & Account Management, Product, Government Services and Trade/Underwriting.
* Engage IT and business leadership to create integrated, comprehensive plans that move IT and the business from current state to future state.
* Hold self and colleagues accountable for achieving results (program, operational, quality, financial and organizational, etc.), and effectively communicate progress with the business to keep them engaged.
* Demonstrate a high level of emotional intelligence: self-awareness, social awareness, self-management and relationship management.
* Partner with peers to identify systemic problems within own area and across PBM IT, and champion continuous improvement/change efforts.
* Lead 5-6 Sr Director and Director level leaders to develop and retain a high-performing, highly engaged workforce.
* Lead 2-3 major, multi-year programs, plus 3-4 technology product lines.

Required Qualifications
* Minimum of 15+ years of IT experience including 4+ years’ experience in role as VP or Sr. Director level managing IT teams focused on application/system architecture & application development
* Experience leading strategic planning for enterprise applications including planning related to scalable growth, performance tuning, and optimization of the systems.
* Experience in developing and managing budgets, strategic planning, process improvement, technical leadership, HR management and staff development.
* Travel up to 10% of the time.

Preferred Qualifications
* RxClaim adjudication application expertise
* Experience with pharmacy claims adjudication software
* Experience with distributed systems and portable languages like Java
* Experience with SDLC methodologies like Agile, SCRUM & XP
* Knowledge of CMS Medicare regulations

Bachelor’s degree in Information Systems, Computer Science, or equivalent related work experience.

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!