Job Profile Summary

Leads automation and AI transformation strategy across the Payment Integrity, Revenue Integrity, and Grievances and Appeals COEs. Builds and manages a team to ideate, prioritize, and oversee delivery of automation and agentic AI initiatives that improve claims accuracy, recovery, and appeals outcomes. Partners with COE and business leadership to align automation roadmaps to enterprise priorities, governance standards, and measurable business impact.

Job Description

A Brief Overview

Leads a team to drive automation and AI-enabled transformation across Payment Integrity, Revenue Integrity, and Grievances and Appeals. Sets strategic direction for how automation and intelligent workflow opportunities are identified and scaled across these COEs, and ensures successful, on-time delivery through strong program oversight. Balances delivery accountability with team development, ensuring the group operates as a cohesive practice rather than three disconnected initiatives.

What you will do

• Leads and develops a team, setting priorities, allocating capacity across COEs, and holding the team accountable to delivery and quality standards.

• Sets the automation transformation strategy for Payment Integrity, Revenue Integrity, and Grievances and Appeals in partnership with COE leadership.

• Ideates and prioritizes automation opportunities across the three COEs, balancing near-term delivery with longer-term capability building.

• Oversees end-to-end delivery of automation initiatives, ensuring outcomes are achieved on time, within budget, and according to defined scope.

• Establishes and maintains strong working relationships with COE and business stakeholders, translating their priorities into an executable roadmap.

• Assesses roadblocks and dependencies, developing mitigation strategies to ensure successful delivery.

• Monitors program budgets, resourcing, and timelines across the portfolio, escalating tradeoffs and risks proactively.

• Reports progress, outcomes, and emerging opportunities to senior leadership, framing impact in terms of business value (accuracy, recovery, cycle time, appeals resolution).

• Builds team capability, coaching Senior Managers on both delivery oversight and people leadership as their own teams grow.

• Identifies and implements process improvements, lessons learned, and industry best practices across the automation lifecycle.

Minimum Requirements

• 10–15 years of experience in automation, process improvement, or program leadership, ideally within healthcare claims, payment integrity, or related operations

• Proven people leadership experience, including managing and developing managers or senior individual contributors

• Adept at translating business priorities into automation delivery roadmaps

• Adept at cross-functional collaboration with COE and business stakeholders at multiple levels

• Mastery of problem solving and decision making, particularly balancing competing priorities across multiple domains

• Mastery of growth mindset skills — agility, self-development, and developing others

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification

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. 

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 .