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Lead Director, Adjudication Benefits
Lead Director, Adjudication Benefits-January 2024
Richardson
Jan 19, 2025
ABOUT CVS HEALTH
CVS Health is a healthcare innovation company. Together, we are helping people on their path to better health.
10,000+ employees
Healthcare
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About Lead Director, Adjudication Benefits

  Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

  Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

   Job Purpose and Summary:

  The Lead Director, PBM Benefits is responsible for managing the PBM Benefits space in the Pharmacy Benefits Management segment. They have accountability for the development, operations and support for AS400 and Mainframe legacy systems as well as web based tool development platforms. This position works closely with other technical leaders of the PBM space & Claims Adjudication team to assess business goals, strategic objectives and to build a comprehensive and achievable multi-year roadmap for the the PBM Benefits teams. This role will be expected to collaborate very closely with Business Stakeholders, Value Pool Product Managers/Owners and Engineering teams in different development environments. They will work closely with senior leaders to ensure that investments are aligned to the Enterprise strategic goals and technology roadmap.

   Primary Job Duties & Responsibilities:

  1. Understands, manages and reports the technical needs across the overall web portfolio of applications and processes used in the management of PBM processes with a focus on delivering high quality business outcomes.

  2. Analyzes operational practices for effectiveness and practicality, while creating a culture which is innovative in its approach to solutions.

  3. Serves as the first point of contact for planning development needs for new initiatives, as well as act as the point of escalation with the existing development resources

  4. Establishes a clear vision aligned with company values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs, budgets, and business success.

  5. Liaises with technical advisors to determine automation, training and enhanced skillsets needed across the portfolio.

  6. Supports both the business and technical understanding of the customer experience, back-end technologies/capabilities and business operations.

  7. Develops an organization that attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed stated goals; builds a cohesive team that works well together and across other technology segment functions.

   Essential Qualifications and Functions: 10+ years experience in IT with an emphasis on engineering development5 + years of cloud development experience3 + years direct managing experience, leading cross-functional teams in a technical environment.Demonstrates a keen awareness of the member experience while seeking opportunities for automation and innovation to reduce dependency on high risk legacy platforms.Experience in identifying and documenting business needs working interactively and effectively with technical resources.Customer-first orientation and strong passion for delivering quality tools, information and content in service to consumer needs.Desire to work collaboratively and experienced in driving projects to completion on time and within budget.Proficient with communication across multiple levels of an organization. Preferred Qualifications: 5 + years of experience with core infrastructure development and integrationSAFe Agile experiencePrior Development Manager experienceUnderstanding of source control, build and test automation, and experience managing DevOps/SecOps practicesExperience with the Azure, AWS and GCP public cloud platforms.Experience with microservices & webservice based API integrationsOur diverse work experience empowers colleagues for career success. In addition to skill and experience, we attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

  CVS Health is an equal opportunity/affirmative action employer. Gender/Race/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT . We provide reasonable accommodations to qualified individuals with disabilities.

  Pay Range

  The typical pay range for this role is:

  $140,000.00 - $280,000.00

  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.

  In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

  For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

  CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

  You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

  CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

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