VP, Adjudication & Eligibility Engineering

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryCVS Health is recruiting for a VP, Adjudication & Eligibility Engineering. This role will be responsible for the pharmacy adjudication systems through strategic planning and delivery, systems modernization, site reliability engineering and operations, and building a solution engineering practice.You will make an impact by:

Collaborate with executive leadership to define and align technology strategy with overall business goals.

Identify emerging technologies, and trends to maintain a competitive edge while increasing speed to market.

Develop and implement a roadmap and strategic plan for industry leading technology products, ensuring alignment with organizational priorities.

Provide strategic leadership and guidance to a large and diverse technology team, fostering a collaborative and innovative work culture.

Oversee the recruitment, development, and retention of top-tier talent across multiple technology disciplines.

Foster a culture of continuous learning and skill development. Provide guidance and feedback on technology projects to ensure timely and high-quality deliverables.

Drive the successful delivery of innovative technical solutions, ensuring the use of cutting-edge technologies and best practices.

Collaborate with cross-functional teams to define and implement effective digital strategies.

Lead and oversee strategic plan for enterprise application design, development, and deployment for Pharmacy Services.

Identify and evaluate digital opportunities that drive competitive advantage and enhance customer value.

Remain technology agnostic, advocating for the best solutions rather than defaulting to common practices, ensuring our services are cutting-edge and competitive.

Develop relationships with key industry and technology leaders to drive and influence future roadmap of solutions.

Drive simple, scalable, flexible, secure, and cost-effective technology design & engineering.

Proactively lead a complex mixture of internal resources and external partners to achieve both best in class technology solutions while achieving speed to market.

Act as key subject matter expert in the rapid, high quality, and global deployment of large scale, enterprise software applications; manages by mature delivery processes & KPI’s.

Lead initiatives for the uplift and modernization of core systems, ensuring scalability, flexibility, and resilience.

Champion reliability and performance excellence through the implementation of Site Reliability Engineering (SRE) practices.

Drive focus on operational excellence throughout the organization & partners, including (but not limited to) processes, governance, efficient working approaches, collaboration.

Ensure smooth operation of applications, monitoring performance and resolving issues proactively.

Establish and oversee strategy for platform reliability and uptime of global application technology solutions.

Establish and monitor key performance indicators (KPIs) to measure the effectiveness and efficiency of technology operations.

Builds a Solution Engineering practice that prides itself on designing simple solutions and empowers teams that hold each other to a higher standard.

Pushes forward the adoption of reference architectures while capitalizing on the investments in existing solution.

Engineer solutions that promote best practices, minimize complexity and architectural layers, and deliver business value.

Collaborate with the Information Security team to implement and maintain robust cybersecurity measures, protecting the company's data and assets.

Establish and enforce security best practices, ensuring the integrity and confidentiality of our systems and data.

Ensure highest level of security hygiene for systems with vulnerabilities addressed with highest priority and urgency.

Cultivate strong relationships with internal and external stakeholders, fostering collaboration and understanding of business needs.

Act as a bridge between technology teams and business stakeholders, ensuring clear and effective communication. Translate technical concepts into understandable terms for non-technical stakeholders.

Promote the value of technology solutions within the organization. Advocate for the adoption of innovative technologies that can enhance business processes and outcomes.

Create channels for feedback from business units regarding technology services and solutions. Use feedback to continuously improve and enhance technology offerings.Demonstrate the business value delivered by technology initiatives.

Provide metrics and insights on how technology investments contribute to achieving strategic business objectives.

Manage appropriate departmental budgets; review/approve related budget expenditures with “act as an owner” mentality.

Develop and manage the technology budget with a focus on cost-effectiveness and efficient resource allocation.

Required QualificationsThe candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

15 or more years of experience with a Degree in Computer Science or equivalent.

Experience building enterprise transaction-based systems with focus on security, reliability, scalability, performance, and modern CI/CD techniques.

Experience in coding, architecting and leading large teams of technologists across multiple time zones and cultures.

Previous experience in design, architecture, and engineering experience of highly available, resilient, scalable systems, including cloud architectures.

Demonstrated knowledge of systems and application technologies and architecture

Demonstrated experience in taking the high-level enterprise strategy and blueprints and converting into system level deliverables for delivery.

Strong understanding of project life cycle methodology and procedures

Experience working in Agile framework and comfortable working in a matrixed organization.

Excellent knowledge of core engineering best practices and passion to implement these across the team.

Demonstrated experience in change management concerning the adoption of modern & innovative technologies.

Strong knowledge of cloud service providers, cloud technology trends, cloud development tools, cloud migration and management and container technologies.

Experience in languages such as AS/400 and similar technologies, including but not limited to Java, Mimix, CL, RPG/RPGLE, COBOL, SYNON, CA/2E, SQL, Aldon, JDBC, ODBC, Direct Connect, Rational Developer, iNavigator, PEX and Database concepts.

Demonstrable cross-functional knowledge with systems, storage, networking, security, and databases

Demonstrated experience with application/technology simplification & rationalization in legacy environments; previous experience in “bi-modal” technology environments that combine digital/agile with enterprise/monolithic applications.

Organized with attention to detail; proven ability to conceptualize, plan and execute ideas while providing training and skills transfer to others.

Experience in understanding business processes from end-to-end context and ability to communicate to business stakeholders in a non-technical manner.

Demonstrated experience in working with various geographically diverse associates and vendor partners.

Demonstrated budget management, tracking, and forecasting skills and experience.

Demonstrated on-time and on-budget system delivery skills and experience.

Demonstrated success in recruiting, growing, retaining, and leading high-caliber technical talent, with a commitment to cultivating and developing internal talent.

Superior relationship building skills with senior management and partners, and important stakeholders.

Experience in setting strategic technology direction and architecture vision encompassing an enterprise view across a large portfolio of capabilities.

Ability to translate short and long-range strategic plans for enterprise-wide architecture into design and implementation of current and future applications.

An ability to combine analytical reasoning, creativity, and judgment in handling complex matters, with multiple initiatives going on simultaneously.

Experience in crafting a collaborative and innovative work culture that encourages risk-taking and fosters excellence.

Excellent communication and interpersonal skills, with the ability to build relationships and influence stakeholders at all levels of the organization.

Experience working in a fast-paced, dynamic environment, with the ability to adapt to change and lead through ambiguity.

Demonstrated success in driving innovation and continuous improvement.

Key Competencies

Facilitating, challenging, and defending technology estimates.

Shepherding technology estimates through the funding and approval process.

Promoting the development of technical knowledge and skills

Facilitating various forums that promote collaboration and knowledge sharing.

High level of communication skills, speaking, writing, and presenting

Contributing to budgetary and planning activities

Developing and maintaining departmental budget and ensures adherence.

Experienced in financial management.

Self-learner and consistently developing themselves.

Training your team and fostering environment of training and enhancing talent

Good judge of talent and building succession plan for the position as well as succession plan for all the leadership and critical positions in the organization

Team player

Has a bias for action

Excellent in execution

Thought leader and challenging status quo.

Customer focus

Preferred Qualifications

Experience with pharmacy claims adjudication platforms.

Experience with CMS Medicare regulations

EducationBachelor's DegreeWe anticipate the application window for this opening will close on: 09/23/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.