Note: The job is a remote job and is open to candidates in USA. CVS Health is a healthcare company focused on creating a more connected, convenient, and compassionate health experience. The Manager, Medical Policy Business Analytics oversees analytics, reporting, performance measurement, and operational intelligence for Medical Policy and Payment Integrity, translating healthcare and operational data into actionable insights. The role also leads dashboard development, data validation, process improvement, governance support, and cross-functional stakeholder coordination.
Responsibilities
- Manage the development and maintenance of performance reporting for Medical Policy, Payment Integrity, and related operational programs
- Develop, maintain, and monitor scorecards, key performance indicators (KPIs), and trend analyses
- Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness
- Identify opportunities to improve affordability, quality, and operational efficiency through data-driven insights
- Prepare clear summaries, dashboards, and presentation materials for leadership review
- Oversee the design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions
- Provide subject matter input on reporting and business intelligence tools and support consistent use of reporting standards
- Partner with data management and technology teams to improve data accessibility and reporting capabilities
- Support delivery of accurate, timely, and actionable reporting for business partners and leadership stakeholders
- Promote self-service analytics and reporting capabilities where appropriate
- Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements
- Support policy governance committees through reporting, trend analysis, and metric development
- Partner with Quality Assurance and Compliance teams to identify and mitigate operational risks
- Support internal audits, regulatory reviews, corrective action plans, and remediation efforts
- Conduct root cause analyses to identify drivers of defects, policy exceptions, rework, and operational inefficiencies
- Support continuous improvement initiatives targeting quality enhancement, defect reduction, and process optimization
- Develop performance improvement recommendations supported by quantitative analysis
- Measure and monitor outcomes associated with process improvement initiatives
- Partner with business stakeholders to gather and document reporting, analytics, and operational requirements
- Support BRD development and translation of business needs into technical solutions
- Support strategic initiatives, system implementations, and transformation efforts by providing analytics, reporting, and business requirements input
- Ensure analytics solutions align with business objectives and operational priorities
- Coordinate cross-functional workgroups, projects, and analytical initiatives to support business objectives
- Present insights, risks, trends, and recommendations to business leaders and cross-functional stakeholders
- Provide consultative support regarding healthcare analytics, reporting methodologies, and performance measurement approaches
- Build strong partnerships across clinical, operational, technology, compliance, and finance organizations
- Support reporting standards and data governance practices
- Ensure data integrity, consistency, and reliability across analytics platforms
- Support data validation, quality monitoring, and issue remediation activities
- Maintain documentation related to reporting methodologies, metric definitions, and data sources
Skills
- Candidate may reside anywhere in the US
- Minimum 5 years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare functions
- Minimum 2 years of experience leading or coordinating projects, analytical workstreams, reporting initiatives, or cross-functional business activities
- Advanced analytical, quantitative, and problem-solving skills leveraging AI
- Experience developing executive dashboards, scorecards, KPIs, and performance reporting
- Experience performing trend analysis, forecasting, root cause analysis, and performance measurement
- Ability to coordinate analytical work, manage competing priorities, and influence stakeholders across a matrixed environment
- Ability to balance day-to-day operational priorities with longer-term business goals
- Ability to communicate complex analytical concepts to technical and non-technical audiences
- Strong stakeholder management and relationship-building skills
- Advanced Microsoft Excel skills
- Experience with Power BI, Tableau, SQL, SAS, Snowflake, Azure Analytics, or similar tools
- Bachelor's Degree or equivalent experience
- Knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations
- Experience supporting enterprise governance committees and executive leadership reporting
- Experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows
- Experience supporting transformation, automation, and operational improvement initiatives
- Experience supporting audit readiness, regulatory reviews, and control monitoring programs
- Knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques
Benefits
- 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 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, based on eligibility.
- Medical coverage, based on eligibility.
- Dental coverage, based on eligibility.
- Vision coverage, based on eligibility.
- Paid time off, based on eligibility.
- Retirement savings options, based on eligibility.
- Wellness programs, based on eligibility.
- Other resources, based on eligibility.
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