Claims Processor Jobs in Springfield, IL (NOW HIRING)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

CVS Health's Analytics & Behavior Change (A&BC) is an organization working to solve some of the most challenging problems at the intersection of technology and healthcare. A&BC leverages advanced analytics, machine learning, modeling, and a hypothesis-driven approach to transform data into actionable, customer-centric insights to drive growth, improve health outcomes and access to health care across all our businesses in CVS Health. Our data teams build next generation data and machine learning platforms and products in the cloud that help CVS Health to make healthier happen for 100+ million customers.

CVS Health is building the next generation of AI-powered tools that transform the fundamentals of claims service operations, including solutions such as AI-powered agentic claims advisor platform and auto adjudication systems and knowledge bases. We are looking for a Director, Product Management-AI Claims Platform to own this portfolio. You will set the “what” and “why” - define vision and roadmap, lead a team of Product Managers, each heading a dedicated cross-functional squad (agile development teams) to deliver measurable impact in a high-stakes enterprise environment.

This is a rare opportunity to own a flagship AI product in healthcare from strategy through delivery — partnering closely with Business executives, Operations teams, Enterprise technology, Data science and Engineering, with strong visibility to senior leadership. This role requires operating with a high degree of autonomy while maintaining credibility across the stakeholders.

• Own the product vision and multi-horizon roadmap for AI-powered claims decision-support and auto adjudication platform, identifying, shaping and prioritizing capabilities

• Translate complex, nuanced claims policies and business operational workflows into a clear, prioritized technology product strategy across Aetna’s commercial and government lines of businesses

• Ensure user-centric design and anchor the product strategy and scope to maximize impact and support future scaling

• Make confident, well-reasoned product decisions amid ambiguity, driving momentum and impact without waiting for perfect information

• Frame investment decisions and tradeoffs for senior executives in terms of measurable outcomes

• Serve as the primary product voice across a highly matrixed enterprise, partnering with business, enterprise technology, data science and engineering, and program leadership.

• Shape how a fast-scaling product organization operates — clarifying roles, decision-making, and ways of working across product life cycle activities.

• Build durable, scalable partnerships with business and subject-matter experts to ensure alignment of vision

• Shape business case and supporting budgeting, investment committee review, and finance reporting processes

• Anticipate and resolve adjacent portfolio dependencies and competing priorities, keeping the broader effort aligned and moving.

• Be primary point of engagement for senior business stakeholders and tailor communication by audience and goals, whether aligning product strategy, driving commercial decisions, or unblocking delivery and anticipating misalignment before it surfaces

• Lead delivery across the portfolio including roadmap, prioritization, milestone, and impact accountability, through a team of product managers, setting clear direction and growing the team while stepping in to perform hands‑on product responsibilities when needed

• Identify and resolve cross-squad and cross functional interdependencies and prioritization trade‑offs

• Responsible for setting, measuring, and leading the team to accomplish product adoption, user change management and business impact goals

• Engage credibly in technical discussions, ensuring solution feasibility and traceability to business and customer requirements

• Partner closely with engineering and data science on the product’s intelligence engine, data foundations, validation and testing systems, coordinating resolution with broader Enterprise partners

• 10+ years in Product Management, with clear progression to Senior / Director-level scope and a track record of owning products end-to-end.

• 5+ years of experience turning complex, ambiguous policy or business rules into reliable product logic in partnership with subject-matter experts.

• 5+ years leading through influence in complex, matrixed organizations, creating clarity and momentum amid ambiguity.

• 3+ years’ hands‑on experience building AI or other advanced‑analytics powered workflow‑automation products in real operational environments, including human‑in‑the‑loop systems where accuracy and trust matter.

• 3+ years of experience with healthcare claims, adjudication systems, or other complex, policy-driven operational workflows.

• 3+ years demonstrating skills as a first‑principles thinker who can get to the root of hard problems and translate them into a clear strategy executives can act on.

• 3+ years of exceptional executive communication — able to distill complex tradeoffs into crisp, compelling narratives for VP+ audiences.

• Familiarity with claims adjudication systems and business rules engines.

• Demonstrated ability to design and evolve how a product organization operates.

• Fluency with the latest ML and agentic approaches, with a clear point of view on where human oversight belongs, guardrails and evaluation strategy.

• Change‑management and adoption‑strategy experience for enterprise tools and software.

• Bachelor’s degree required, preferably in a quantitative, analytical, or technical field (e.g., Data Science, Statistics, Computer Science, Health Informatics, Economics, or related discipline).

• MBA or advanced degree preferred.

The typical pay range for this role is:

$144,200.00 - $288,400.00

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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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.

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

We anticipate the application window for this opening will close on: 07/25/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.