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CVS Health
Manager – MPPS Policy Business AnalyticsCVS Health • Remote, Connecticut, United States
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Manager – MPPS Policy Business Analytics

Manager – MPPS Policy Business Analytics

CVS Health • Remote, Connecticut, United States
6 days ago
Job type
  • Full-time
  • Remote
Job description

Job Description:

  • Manage analytics, reporting, performance measurement, and operational intelligence activities supporting Medical Policy and Payment Integrity
  • Develop, maintain, and monitor scorecards, KPIs, trend analyses, dashboards, and performance reporting
  • 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 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, compliance, 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
  • Develop performance improvement recommendations and monitor initiative outcomes
  • Gather and document reporting, analytics, and operational requirements
  • Support BRD development, system implementations, strategic initiatives, 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, metrics, and data sources

Requirements:

  • 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
  • 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 preferred
  • Bachelor's Degree or equivalent experience

Benefits:

  • CVS Health bonus, commission or short-term incentive program in addition to base pay
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
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Manager – MPPS Policy Business Analytics • Remote, Connecticut, United States

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