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.

·       More predictable delivery of regulatory, client and strategic commitments, with transparent measures of progress, value, quality and risk.

·       A strong leadership bench and engineering culture that can operate effectively through ambiguity, pressure and continuous change.

·       Innovation translated into practical outcomes, not technology for its own sake.

 
Required Qualifications
·       15+ years of progressive experience in technology, software engineering, application delivery or platform leadership, including leadership of large, complex organizations and enterprise portfolios over $50M+ accountability.

·       Demonstrated success leading deep technology and business transformation in a large, matrixed and highly regulated environment.

·       Experience owning mission-critical platforms with demanding requirements for availability, performance, resilience, security and operational support.

·       Proven ability to lead large-scale transformation involving core platforms, AI, cloud technologies, service-based or microservices architectures, enterprise application integration, API strategy and lifecycle management, and system interoperability.

·       Strong financial and portfolio management experience, including investment prioritization, workforce planning, vendor management and delivery accountability.

·       Exceptional stakeholder management and influencing skills, with the ability to align senior business and technology leaders around difficult choices and shared outcomes.

·       Ability to move comfortably between strategy and technical detail, communicate complex issues in plain language and make sound decisions under pressure.

·       Demonstrated success leading organizational change, building high-performing leadership teams and creating a culture of accountability, innovation and continuous improvement.

Preferred Qualifications
·       Deep knowledge of pharmacy benefit management, health care claims processing, benefit administration, clinical & formulary, pharmacy networks or related health care transaction ecosystems.

·       Experience with prescription claims adjudication platforms, high-volume real-time transaction processing workloads, and National Council for Prescription Drug Programs standards.

·       Experience operating in environments governed by health care privacy, security and regulatory requirements, including HIPAA.

·       Experience applying artificial intelligence, automation, modern software delivery and observability practices to improve engineering productivity and business operations.

·       Advanced degree in computer science, engineering, business or a related field.
Education
  Bachelor’s degree or equivalent relevant experience.

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.