Executive Director, Adjudication Software Engineering & Transformation

Position Summary

Are you interested in joining Fortune 6 CVS Health as part of our dynamic Information Technology team? If you are seeking a leadership opportunity where you can truly have influence and are enthusiastic about doing what’s right, we invite you to consider the role of Executive Director, Adjudication Software Engineering & Transformation, where you will lead software engineering and transformation of adjudication ecosystem spanning Eligibility, Member Data Transition, Drug and Pharmacy domains, and Managed File Transfer.

• Lead and scale a high‑performing software engineering organization responsible for applications across eligibility, member, drug, pharmacy and integration services, spanning both cloud (Azure, GCP) and legacy platforms (IBMi, Mainframe).
• Utilize cloud technologies to develop and implement modern data domain solutions.
• Analyze use cases and create innovative solutions that meet business needs.
• Partner and co‑lead solution engineering discipline, guiding and mentoring talent in implementing solutions across various technology platforms.
• Collaborate with stakeholders to understand business processes, challenges, and objectives, translating these into effective implementation plans.
• Assess issue risks and develop mitigation strategies to minimize impact on clients.
• Build and execute on the data exchanges strategy to streamline and simplify different data exchanges in PBM.
• Provide strategic direction to co‑develop and execute our modernization vision on “Adjudication as a Service” by creating single sources of truth within domain contexts.
• Innovate by adopting and implementing AI into business processes and software engineering.
• Focus on strategies to reduce the cost of change, deploy automation, increase speed to market, enhance technology relevance, and ensure platform scalability and serviceability.
• Establish and implement application development standards to promote modularization of adjudication functions and the creation of domain services for a consistent client and member experience.
• Manage overall delivery, ensuring quality, design, timeliness, budget adherence, and alignment with key OKRs and KPIs.
• Oversee IT budget, resources, and vendors delivering IT projects and services in alignment with OKRs.
• Maintain effective communication and collaboration with business stakeholders, vendors, and external partners, meeting business requirements and expectations and resolving issues or escalations.
• Ensure compliance of systems and applications with company policies, standards, and regulations, identifying, assessing, and mitigating risks and controls.
• Promote a culture of innovation and strategic thinking within the organization, encouraging new ideas and continuous improvement in business and technical processes.
• Inspire and mobilize teams toward talent development, creating an environment that fosters the acquisition of new skills and continuous improvement.
• Address challenges related to organic growth, system performance, and end‑of‑life software/hardware while ensuring compliance with regulatory requirements.

• 12+ years in Healthcare IT, including 4+ years at director‑level, leading teams in application/system architecture & development on cloud technologies.
• 10+ years in client‑facing support, handling production issues, cross‑functional resolution, executive reporting, and SLA adherence.
• Proficient at managing cross‑functional issues and leading diverse teams without direct authority.
• 5+ years leading and scaling support operations.
• Experience in AI technologies.
• Proficient in cloud engineering and designing scalable, secure cloud infrastructure.
• Strategic planning for enterprise applications, focusing on growth, performance tuning, and optimization.
• Analyzed enterprise platforms, identified deficiencies, and recommended improvements.
• Experienced in budgets, strategic planning, process enhancement, technical leadership, HR management, and staff development.
• Travel up to 10%.

• Experience in AS/400 and Mainframe related technologies.
• Strong knowledge and experience in IT vendor management and IT service management…