Executive Director, Appeals Process & Technology

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The Executive Director, Appeals Process & Technology leads a critical function responsible for driving the coordinated effort to migrate Aetna Grievances & Appeals business processes to a modernized technology platform.

Primary Responsibilities

Product Model Business General Manager

• Partner closely with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting capabilities, and improve operational scalability.
• Define and communicate the long-term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures.
• Provide executive guidance to ensure business requirements and outcomes are integrated into technology delivery plans.
• Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders.
• Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners.

Investment Prioritization, Management & Impact Tracking

• Lead development of business cases and establish investment priorities in partnership with A&G functional leaders, DDAT, and other stakeholders.
• Make enterprise-level trade-off decisions related to scope, sequencing, funding, and business value.
• Oversee program and technology spend, ensure budget discipline, and track expected business benefits and operational efficiencies.

Policies, Workflows & Training Coordination

• Lead teams in developing and updating policies, workflows, and job aids in partnership with accountable Operations teams.
• Ensure new platform functionality and business processes are reflected in consistent workflows while balancing the need to minimize system customization with plan sponsor requirements.
• Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training.

Process Assurance (Quality) Strategy & Operations

• Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and well understood.
• Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness.
• Use process assurance findings to strengthen policies, workflows, training, and operational processes.

Required Qualifications

• 15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
• Proven experience leading leaders and large-scale, front-line operational teams.
• Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes.
• Strong health plan operations experience; experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions is highly valued.
• Strong operational acumen, including workforce management, workflow optimization, process improvement, productivity, quality, and compliance.
• Proven ability to lead complex initiatives across Operations, Product, Technology, Compliance, Medical/Clinical, and other enterprise functions.
• Experience developing business cases, prioritizing investments, managing budgets, and using operational and financial data to drive decisions.
• Working knowledge of CMS, state regulatory requirements, HIPAA, privacy, and audit readiness.
• Executive presence with the ability to influence senior leaders and communicate complex information clearly and effectively.
• Bachelor’s degree or equivalent experience required; advanced degree preferred.

Pay Range The typical pay range for this role is: $131,500.00 - $303,195.00

Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.