Position SummaryThe Lead Director, Individual Medicare Service Operations is responsible for providing strategic leadership and operational oversight for Individual Medicare Advantage, Medicare Dental and Dual Special Needs Plan (DSNP) service operations. This role drives operational excellence, member experience, quality outcomes, and business performance while supporting growth and innovation across the Medicare organization.
The successful candidate will work closely with market leaders, product, network, clinical, digital, compliance, quality, operations, and vendor partners to execute key Medicare priorities and deliver a differentiated member experience. This leader will balance strategic planning, operational execution, regulatory requirements, and stakeholder engagement while fostering a culture of accountability, collaboration, and continuous improvement.
Key Duties and Responsibilities- Provide strategic leadership and operational oversight for Individual Medicare, Medicare Dental and DSNP service operations.
- Develop and execute strategies that improve member experience, operational performance, quality outcomes, and financial stewardship.
- Partner across the Medicare organization to support growth initiatives, operational readiness, member retention, and service excellence.
- Collaborate with Product, Market, Clinical, Network, Digital, Technology, Compliance, Quality, and Service Operations leaders to drive enterprise priorities.
- Lead relationships with key vendor and business process outsourcing partners, ensuring performance expectations, service quality, and contractual obligations are achieved.
- Drive operational improvements through data analytics, performance monitoring, process optimization, and continuous improvement initiatives.
- Support and influence critical Medicare initiatives, including:
- CMS Star Ratings
- CAHPS and member experience strategies
- DSNP operational excellence and growth
- Digital transformation and self-service adoption
- Regulatory and compliance readiness
- Annual Enrollment Period (AEP) operational readiness
- Accountable for achieving service, quality, member experience, efficiency, and operational performance goals.
- Partner with stakeholders to identify risks, develop mitigation strategies, and ensure successful implementation of business initiatives.
- Lead complex cross-functional projects and organizational change initiatives across the Medicare enterprise.
- Manage departmental budgets, workforce planning, and expense management to support organizational objectives.
- Foster strong relationships with internal and external stakeholders to ensure alignment and execution of business priorities.
- Lead, coach, and develop a high-performing team through mentoring, succession planning, performance management, and talent development.
- Attract, retain, and develop diverse talent while promoting an inclusive and engaged work environment.
- Champion innovation, operational excellence, accountability, and member advocacy throughout the organization.
Required Qualifications- Medicare knowledge and experience required, particularly Medicare Advantage Plans.
- Knowledge of Individual Medicare products, member service operations, and D-SNP programs.
- 7+ years of leadership experience managing large-scale healthcare, Medicare, service operations, or contact center organizations.
- Proven success setting strategic direction and leading change that resulted in measurable business outcomes.
- Experience leading complex projects, programs, and enterprise initiatives across a matrixed organization.
- Demonstrated ability to build effective partnerships and influence senior leaders, stakeholders, and cross-functional teams.
- Experience managing vendor relationships and performance governance.
- Strong financial, operational, and analytical acumen.
- Demonstrated experience driving operational excellence, service quality, and member experience improvements.
- Proven ability to communicate effectively with executive leadership, business partners, and external stakeholders.
Preferred Qualifications- Individual Medicare service operations experience.
- D-SNP and Special Needs Plan experience.
- CMS Star Ratings, CAHPS, and Medicare quality program experience.
- Vendor management and outsourcing partnership experience.
- Contact center and member advocacy leadership experience.
- Experience supporting Medicare growth initiatives, AEP readiness, and operational implementations.
- Experience leading digital transformation, self-service, AI-enabled service models, or operational modernization initiatives.
EducationBachelor's degree or equivalent experience/equivalent military experience.
Pay RangeThe typical pay range for this role is:
$100,000.00 - $231,540.00
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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/14/2026
