The Director, Cost Management – Affordability is responsible for leading the development, implementation, monitoring, and evaluation of enterprise affordability initiatives designed to improve healthcare value, manage cost trends, and support long-term financial sustainability.
Compensation
Posting Salary Range: $106,913 - $139,910
Responsibilities
Identify opportunities to improve affordability through analysis of utilization, expenditure, reimbursement, and service delivery trends
Partner with operational and clinical leaders to identify root causes of cost growth and utilization variation
Develop financial assessments supporting affordability opportunities and strategic initiatives
Quantify projected savings, implementation costs, required resources, and expected return on investment
Communicate initiative progress, financial impacts, risks, and mitigation plans to senior leadership
Requirements
Bachelor's degree
Master’s degree in Business Administration, Healthcare Administration, Finance, Nursing, Public Health, Healthcare Informatics, Economics
Nice to have: Supervision of two (2) or more employees
Nice to have: Project Management Professional (PMP) certification
The Executive Director, Claims & Payment Integrity Strategy will report to the VP, Claims & Payment Integrity of Aetna and serve as the central strategic integrator across the end‑to‑end claim lifecycle, accountable for aligning Claims & PI strategic plan, operational oversight, capital submissions and overall structure of the team.
Compensation
The typical pay range for this role is: $131,500.00 - $303,195.00. 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. 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.
Responsibilities
Partner with Claims & Payment Integrity (CPI) leadership to develop and execute the enterprise strategy across 12‑month, 3‑year, and 5‑year+ horizons.
Establish a cohesive end‑to‑end CPI operating model that integrates people, process, technology, and vendor capabilities across the full claim lifecycle.
Serve as the single point of strategic coordination for initiatives combining multiple CPI teams and capabilities.
Document and maintain a clear CPI strategic roadmap, ensuring cross‑functional alignment across DDAT, ACS, Reporting, Finance, Procurement, Operations, and other stakeholders.
Create and manage governance forums, operating cadences, and decision frameworks to keep workstreams aligned while balancing transformation with day‑to‑day operational performance.
Play a strategic role in advancing healthcare affordability through data-driven insights and financial analysis, supporting payment integrity initiatives.
Compensation
Competitive annual salary: $112,800–$188,000, depending on relevant experience, qualifications, and geographic location.
Responsibilities
Drive medical cost analytics: Identify trends, emerging risks, and cost-saving opportunities across payment integrity and cost containment programs to support broader healthcare affordability objectives.
Translate data into strategic insights: Interpret complex analytical findings and communicate clear, actionable recommendations to technical teams, operational stakeholders, and senior executives.
Develop financial assessments: Own financial impact analyses and business cases for strategic initiatives, including forecasting, variance analysis, financial modeling, and recommendations to improve program performance.
Monitor program effectiveness: Evaluate pre-payment and post-payment editing programs, clinical coding audits, and recovery initiatives through dashboards, performance scorecards, and executive reporting materials.
Identify cost recovery opportunities: Analyze billing patterns, coding practices, reimbursement methodologies, and claims data to identify and quantify potential savings, inappropriate payments, waste, and abusive practices.
Requirements
Bachelor's degree in a quantitative or related discipline, such as Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, or Applied Mathematics
Support Coordination of Benefits (COB) efforts for Payment Integrity, investigating and verifying proper payment of medical and pharmacy claims, creating and enhancing COB workflows, and driving audits.
Locations (7)
Atlanta, Georgia, United States
Chicago, Illinois, United States
Dallas, Texas, United States
Louisville, Kentucky, United States
Minneapolis, Minnesota, United States
Sr Project Manager- Strategic Implementations ACAS
Plans, monitors and manages internal projects from initiation through completion, primarily focused around Payment Integrity products, acting as a top-level specialist in project management for technical deployments on the ACAS platform.
Compensation
The typical pay range for this role is: $82,940.00 - $182,549.00. 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. 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.
Responsibilities
Plans, monitors and manages internal projects from initiation through completion
Secures required resources and uses formal processes and tools to manage resources, budgets, risks and changes
Manages projects to ensure on-time completion according to specifications and within budgeted costs
Acts as a top-level specialist in project management for technical deployments on the ACAS platform
Adapts project management methodologies and best practices to meet the unique needs of each project
The Vice President, Claims and Provider Operations leads the strategy, performance, and modernization of claims, configuration, provider data, payment integrity, and capitation operations.
Compensation
Base Pay Range: $260,000-$325,000, Salary + Incentive Plan
Responsibilities
Leads a multi-disciplinary organization across claims intake, adjudication, configuration, provider data operations, payment integrity, capitation, and operational support, ensuring alignment with enterprise strategy, regulatory requirements, financial performance, provider experience, and member outcomes.
Owns end-to-end operational accuracy, timeliness, compliance, and control performance across claims and provider operations, with accountability for claims turnaround time, auto-adjudication rate, pend rate, inventory aging, financial accuracy, procedural accuracy, payment accuracy, prompt-pay compliance, and avoidable interest exposure.
Leads the evolution and transformation of claims and provider operations through workflow simplification, delivery model optimization, elimination of unnecessary manual touchpoints, automation, artificial intelligence, predictive analytics, and continuous improvement practices that improve quality, productivity, scalability, cost per claim, and speed to resolution.
Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and enterprise initiatives.
Lead healthcare payer consulting engagements focused on payment integrity and payer operations, managing teams and delivering client-ready recommendations.
Locations (3)
Minneapolis, Minnesota, United States
Washington, D.C., District of Columbia, United States
United States
Responsibilities
Lead teams and manage work through direct and indirect reports
Deliver projects on time
Translate analysis and stakeholder feedback into clear, client-ready recommendations
Translate analysis and stakeholder feedback into clear, client-ready recommendations
The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
Contribute as a subject matter expert for Oscars COB reimbursement policies
Respond to internal and external inquiries and disputes regarding COB policies
Use knowledge gained through research and claims review to ideate COB opportunities and translate into business requirements
Ingest information from internal and external partners regarding adverse claim outcomes and collaborate to scope, size, prioritize items and deliver COB solutions
Use insights from partner submissions, process monitoring, etc., to proactively identify thematic areas of opportunity to solve COB problems
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