Lead Director, Adjudication Benefits

Are you a seasoned leader with a strong background in healthcare and adjudication? Are you passionate about driving operational excellence and delivering exceptional customer service? If so, we have an exciting opportunity for you to join our team as the Lead Director of Adjudication Benefits at CVS Health.As the Lead Director, you will be responsible for overseeing and directing the adjudication process for all benefit plans, ensuring accuracy, efficiency, and compliance. You will also play a critical role in developing and implementing strategies to optimize the adjudication process and enhance the overall member experience.To be successful in this role, you must have a minimum of 10 years of experience in healthcare adjudication, with at least 5 years in a leadership role. You should also possess strong analytical skills, excellent communication and interpersonal skills, and a track record of driving results and managing high-performing teams.If you are a dynamic and results-driven leader who is committed to making a positive impact on the healthcare industry, we want to hear from you. Join us at CVS Health and be a part of a team that is dedicated to making a difference in the lives of our customers.

1. Oversee and direct the adjudication process for all benefit plans, ensuring accuracy, efficiency, and compliance.
2. Develop and implement strategies to optimize the adjudication process and enhance the overall member experience.
3. Monitor and analyze adjudication data to identify trends and areas for improvement.
4. Collaborate with cross-functional teams to implement process improvements and resolve adjudication-related issues.
5. Manage and mentor a team of adjudication professionals, providing guidance and support to ensure high performance and development.
6. Stay updated on industry trends and regulations related to healthcare adjudication and make recommendations for adjustments to processes and procedures as needed.
7. Act as a subject matter expert on adjudication processes and provide guidance and support to other departments as needed.
8. Ensure compliance with all regulations and policies related to adjudication, including HIPAA and other privacy laws.
9. Monitor and manage department budget, making recommendations for cost-saving measures and ensuring efficient use of resources.
10. Communicate regularly with upper management and stakeholders on the status and performance of the adjudication process.
11. Develop and maintain relationships with external partners, such as vendors and payers, to ensure smooth and efficient adjudication processes.
12. Conduct regular performance evaluations for team members and provide ongoing coaching and feedback to support their growth and development.
13. Act as a liaison between the adjudication team and other departments, fostering a collaborative and positive work environment.
14. Prepare and present reports and presentations on adjudication processes and performance to senior leadership.
15. Remain up-to-date on the latest technologies and innovations in healthcare adjudication and make recommendations for their implementation to improve processes and outcomes.

According to JobzMall, the average salary range for a Lead Director, Adjudication Benefits is $150,000-$250,000 per year. This may vary depending on the specific job responsibilities, location, and company. Some companies may also offer additional benefits and bonuses.

CVS Health Corp. engages in the provision of health care services. It operates trough the following segments: Pharmacy Services, Retail or Long Term Care, and Corporate. The Pharmacy Services segment offers pharmacy benefit management solutions. The Retail or Long Term Care segment includes selling of prescription drugs and assortment of general merchandise. The Corporate segment involves in providing management and administrative services.