Associate Vice President, Adjudication 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
CVS Health is seeking an exceptional technology leader to serve as Associate Vice President of Adjudication Services for CVS Caremark. This leader will own the technology strategy, transformation, delivery and operational performance of the prescription claims adjudication platform and its broader ecosystem across Commercial Programs, Government Services and Enterprise Strategic initiatives. The role carries end-to-end accountability for a mission-critical business outcome - processing prescription claims reliably, securely and at scale while evolving the platform for the future.

This is not a traditional application delivery role. It is an opportunity to lead one of the most consequential technology portfolios in Pharmacy Services, unify complex organizations behind a clear direction, and continue to simplify a platform that sits at the center of member, client, pharmacy and business operations. The successful candidate will combine deep technical judgment, business acumen, organizational change leadership and the ability to deliver with discipline under significant pressure.

Reporting to the Vice President, Adjudication and Client Experience Engineering, this AVP will lead a team of 500+ engineers and steward a $60M+ technology portfolio in support of Pharmacy Services outcomes across Commercial Programs, Government Services and Strategic adjudication initiatives.

What You Will Do

· Mission-critical outcomes. Be accountable for the availability, performance, accuracy and compliance of the claims processing platform that our clients, members, pharmacies and partners rely on every minute of every day.

· One strategy across Commercial, Government and Strategic portfolios. Create a North Star vision for the adjudication services ecosystem and turn it into an executable roadmap that aligns people, process and technology

· Transformation through Innovation. Provide hands-on impetus to the ongoing shift from existing applications to a cloud-native, microservices-based, domain-driven architecture while keeping the claims processing platform highly efficient. Drive the move from project to product, and modernize the experience layers that sit on top of established platforms.

· Integration and interoperability. Set the direction for API first strategy, governance and lifecycle management, and for real-time and batch integration across internal platforms, clients, prescribers, networks and external partners.

· AI and automation. Embed AI, DevSecOps, test automation and simplified architecture into how we build and run the platform, with the goal of moving the organization from reactive operations to predictive operations. We measure success by cycle time, throughput and quality, not by activity.

· Business partnership. Partner as a peer with senior leaders across Operations, Product, Client Services, Network Management, Pricing, Data and Integration Services, and Client Experience Engineering to prioritize investments and deliver shared results.

· Portfolio and financial stewardship. Manage a large multi-program investment portfolio and cost base, ensuring delivery that is on time, on budget and at the quality our business demands. Build business cases that fund innovation and disruption.

· Resilience and regulatory excellence. Anticipate growth, performance and end-of-life risks before they become problems, and ensure compliance with HIPAA, NCPDP, CMS and other regulatory requirements across every program.

· People and culture. Lead, grow and inspire a high-performing organization of exec directors, directors, managers, engineers and partners. Build a culture of innovation, accountability and continuous improvement, and develop the next generation of senior technology leaders.

· Ecosystem and industry leadership. Partner with technology providers and third parties to accelerate innovation, and stay ahead of industry shifts, new business models and emerging technology so our platform is ready for what comes next.

What Success Looks Like

· A unified adjudication services organization with clear accountability, faster decisions and stronger alignment across Commercial, Government and Strategic priorities.

· Reliable and resilient claims processing that sustains business continuity while the platform is transformed.

· A focused transformation roadmap that reduces complexity, improves speed and creates reusable platform capabilities without introducing unnecessary operational risk.

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