Lead Director, Payment Integrity, CVS Health

CVS Health

Location:
United States

Category:
Finance

Contract Type:
Employment contract

Salary:

100000.00 - 231540.00 USD / Year

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Job Description:

Leads team to develop enterprise-wide solutions (medical cost containment and payment integrity) to address business problems, resulting in lower cost of care for clients and members enabling the organization to be competitive in the marketplace and effectively serve its customers. Responsible for the out of network product portfolio, market analysis, creative and new solutions, pricing and profitability strategies.

Job Responsibility:

Leads team of approximately 6 employees and overall scope of 25-30 to develop enterprise-wide solutions (medical cost containment and payment integrity)
Responsible for the out of network product portfolio, market analysis, creative and new solutions, pricing and profitability strategies
Measures performance and ensures regulatory compliance to achieve business objectives
Collaborates across the organization to optimize the achievement of strategic business objectives
Responsible for out of network (cost management) products, savings, revenue, financial results and commitments
Works closely with sales, account management, and operations to resolve problems and ensure client needs are met
Evaluates new business opportunities, fosters innovation, and adapts strategies to meet evolving market conditions
Explores opportunities for digital transformation, process optimization, and adoption of new technologies
Contributes to planning budgets for strategic initiatives and programs
Conducts market research, analyzes customer needs, and monitors industry trends
Communicates with cross-functional teams to ensure alignment of product strategy
Identifies and pursues new business opportunities to drive growth and revenue
Provides regular reports and updates regarding business operations and financial performance
Provides leadership, mentorship, and guidance to the team

Requirements:

Minimum 8 years in healthcare industry experience in product, finance, operations, network/out of network, payment integrity, and/or related disciplines
Proven leadership/management experience
Market exposure to account management, sales, brokers, and clients
Proven ability to analyze and interpret complex data sets to develop actionable strategies
Strong communication skills, including experience presenting to senior leadership
Strong analytical abilities with proficiency in data interpretation and financial modeling
Ability to influence and drive change within a complex organizational structure
Growth mindset, creative solutions, problem solver, quick decision maker
Self-motivator, works well independently
Strong leadership, collaboration and teamwork
Bachelor's degree preferred/specialized training/relevant professional qualification

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 10, 2025

Expiration:
September 25, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Lead Director, Payment Integrity

CVS Health

Location:United States

Category:Finance

Contract Type:Employment contract