Hispanic Alliance for Career Enhancement
Healthcare Analytics Business Consultant (SQL / Python)
Hispanic Alliance for Career Enhancement, Granite Heights, Wisconsin, United States
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues—caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
This is an individual contributor
This position can sit anywhere in the United States, but must work East Coast hours
Position Summary We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This is a full time role and is ideal for a data professional with strong coding skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role.
Job Responsibilities
Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets.
Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity.
Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and standards.
Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences.
Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements.
Develop and participate in presentation and consultation with business partners on data, capabilities and performance results.
Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity.
Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.
Required Qualifications
A minimum of 3 years of data interpretation and analysis experience, preferable in the health insurance or Medicaid program.
Ability to distill complex data into meaningful insights and present findings to non-technical audiences.
2+ years experience interpreting medical claim data.
Advanced experience in SQL & Python coding sourcing from a data warehouse.
3+ years of project leadership experience.
Strong business as well as systems knowledge.
Excellent problem-solving, critical thinking, and written communication skills.
Advanced experience in Excel.
Preferred Qualifications
Experience in healthcare fraud, waste and abuse.
Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting.
Experience with data visualization tools (e.g., Tableau, Power BI).
Familiarity with Big Query & Jupyter Notebook.
Education
Bachelor's degree preferred or a combination of work experience and education.
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical pay range for this role is: $54,300.00 - $145,860.00 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
This is an individual contributor
This position can sit anywhere in the United States, but must work East Coast hours
Position Summary We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This is a full time role and is ideal for a data professional with strong coding skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role.
Job Responsibilities
Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets.
Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity.
Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and standards.
Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences.
Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements.
Develop and participate in presentation and consultation with business partners on data, capabilities and performance results.
Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity.
Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.
Required Qualifications
A minimum of 3 years of data interpretation and analysis experience, preferable in the health insurance or Medicaid program.
Ability to distill complex data into meaningful insights and present findings to non-technical audiences.
2+ years experience interpreting medical claim data.
Advanced experience in SQL & Python coding sourcing from a data warehouse.
3+ years of project leadership experience.
Strong business as well as systems knowledge.
Excellent problem-solving, critical thinking, and written communication skills.
Advanced experience in Excel.
Preferred Qualifications
Experience in healthcare fraud, waste and abuse.
Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting.
Experience with data visualization tools (e.g., Tableau, Power BI).
Familiarity with Big Query & Jupyter Notebook.
Education
Bachelor's degree preferred or a combination of work experience and education.
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical pay range for this role is: $54,300.00 - $145,860.00 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 10/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr