Executive Director, Appeals Process & Technology – Aetna

The Executive Director, Appeals Process & Technology leads a critical function responsible for driving the coordinated effort to migrate Aetna Grievances & Appeals business processes to a modernized technology platform. This role owns the strategy and execution of a large, complex, cross-functional program to create more efficient and consistent processes, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements. The role requires a proven operator who can lead through complexity, influence at the executive level, and build high-performing teams within a highly matrixed environment.

Responsibilities

Lead the strategy and execution of a large, complex, cross-functional program to migrate Aetna Grievances & Appeals business processes to a modernized technology platform; Partner with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions; Define and communicate the long-term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures; Provide executive guidance to ensure business requirements and outcomes are integrated into technology delivery plans; Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders; Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners; Lead development of business cases and establish investment priorities; Make enterprise-level trade-off decisions related to scope, sequencing, funding, and business value; Oversee program and technology spend, ensure budget discipline, and track expected business benefits and operational efficiencies; Lead teams in developing and updating policies, workflows, and job aids; Ensure new platform functionality and business processes are reflected in consistent workflows while minimizing system customization with plan sponsor requirements; Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training; Lead process assurance and quality routines across A&G Operations teams; Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness; Use process assurance findings to strengthen policies, workflows, training, and operational processes

Requirements

15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment; Proven experience leading leaders and large-scale, front-line operational teams; Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes; Strong health plan operations experience; experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions is highly valued; Strong operational acumen, including workforce management, workflow optimization, process improvement, productivity, quality, and compliance; Proven ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions; Experience developing business cases, prioritizing investments, managing budgets, and using operational and financial data to drive decisions; Working knowledge of CMS, state regulatory requirements, HIPAA, privacy, and audit readiness; Executive presence with the ability to influence senior leaders and communicate complex information clearly and effectively; Bachelor's degree or equivalent experience required

Nice to have

Advanced degree preferred; Experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions

Benefits

Medical, dental, and vision coverage; Paid time off; Retirement savings options; Wellness programs; Other resources based on eligibility; Eligibility for CVS Health bonus, commission or short-term incentive program; Award target in the company's equity award program