Executive Director, Appeals Process & Technology – Aetna

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 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. Primary Responsibilities Product Model Business General Manager • Partner closely with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting capabilities, and improve operational scalability. • 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. Investment Prioritization, Management & Impact Tracking • Lead development of business cases and establish investment priorities in partnership with A&G functional leaders, DDAT, and other stakeholders. • 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. Policies, Workflows & Training Coordination • Lead teams in developing and updating policies, workflows, and job aids in partnership with accountable Operations teams. • Ensure new platform functionality and business processes are reflected in consistent workflows while balancing the need to minimize system customization with plan sponsor requirements. • Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training. Process Assurance (Quality) Strategy & Operations • Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and well understood. • 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. Required Qualifications • 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 opera