Manager – Medical Policy Business Analytics

Job not on LinkedIn

🔥 29 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $54.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Manage analytics, reporting, performance measurement, and operational intelligence activities supporting Medical Policy and Payment Integrity functions • Translate healthcare, claims, policy, utilization, and operational data into actionable insights • Develop and maintain performance reporting, scorecards, KPIs, and trend analyses • Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness • Prepare summaries, dashboards, and presentation materials for leadership review • Oversee design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions • Partner with data management and technology teams to improve data accessibility and reporting capabilities • Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements • Support governance committees, internal audits, regulatory reviews, corrective action plans, and remediation efforts • Conduct root cause analyses and support continuous improvement, defect reduction, and process optimization • Gather and document reporting, analytics, and operational requirements; support BRD development and translation into technical solutions • Support strategic initiatives, system implementations, and transformation efforts • Coordinate cross-functional workgroups, projects, and analytical initiatives • Present insights, risks, trends, and recommendations to leaders and stakeholders • Support data governance, validation, quality monitoring, issue remediation, and documentation of reporting methodologies, metric definitions, and data sources

🎯 Requirements

• 5+ years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare functions • 4+ 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 with 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 • Preferred: knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations • Preferred: experience supporting enterprise governance committees and executive leadership reporting • Preferred: experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows • Preferred: experience supporting transformation, automation, and operational improvement initiatives • Preferred: experience supporting audit readiness, regulatory reviews, and control monitoring programs • Preferred: knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility