Payment Integrity Escalations Director

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

A Brief Overview The Lead Director Payment Integrity Escalations and Rework oversees the implementation of the process improvement strategy as it pertains to Payment Integrity and its impact on re-work and responsible for creating a Payment Integrity Escalations process that aligns with the broader Service Operations Escalation process. This leader will leads teams in the identification and resolution of process issues, re-work initiatives and serves as the main point of contact/liaison for internal and external customers as it pertains to Payment Integrity Escalations.

What you will do

o Communicates with top management on the dynamics of the end-to-end processes and uncovers opportunities related to Payment Integrity & Re-work resolution

o Communicates strategically across business units to understand business priorities, goals, and success measures.

o Contributes to business objectives and develops documentation for business process requirements that support department needs for creating and executing on an escalation process / pathway.

o Contributes to top-level decision making on process design to enhance productivity and ensure clarity in process execution.

o Responsible for understanding Payment Integrity claim lifecycle to help leaders examine workflows and systems to identify bottlenecks and inefficiencies.

o Designs (or participates in design) performance indicators to enable data-driven decision making around escalations and re-work.

o Determines potential process improvements based on department needs; considers technology solutions to streamline new processes.

o Develops risk management processes to identify potential risks and ensure adherence to legal and regulatory compliances

o Develops a cross-functional high performing team of department heads, experts, and external partners to align processes across different functions to achieve organizational objectives.

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Required Qualifications

• 10+ years work experience in standing up new products / processes
• 5 years of experience in claims re-work
• 10 years of experience of escalation management / oversight
• 5+ years experience in working with healthcare providers

Preferred Qualifications
Comfortable working in high pressure environments

Education

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

Pay Range

The 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.

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.

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: 05/02/2026

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