CVS Health
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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.
Position Summary
The Sr. Mgr. Business Analytics is responsible for developing, maintaining, and automating reports and dashboards that track the performance of medical and payment policies. By delivering data-driven insights to leadership and other stakeholders, this role helps optimize business processes, ensure policy compliance, and identify opportunities for efficiency improvements and cost savings. Data Analysis & Reporting
Extract, validate, and interpret large datasets from healthcare claims, authorizations, and payment systems. Conduct exploratory data analysis to identify patterns, trends, and deviations in payment or utilization. Evaluate medical and payment policy operations, identifying trends, patterns, and variances related to: Medical cost drivers and utilization patterns. Analyze effectiveness of medical and pre-payment policies, and precertification for delivery of insights on performance to leadership. Operational efficiency metrics, such as turnaround times and productivity. Policy compliance and adherence to regulatory requirements. Policy Quality & Compliance
Review payment policies and procedures for accuracy, identifying gaps and potential inaccuracies. Ensure adherence to medical policies and regulatory requirements, such as federal and state legislation and HIPAA. Participate in the design and deployment of algorithms or automated edits to ensure correct payment and prevent overpayments. Business Process & System Improvement
Collaborate with stakeholders to gather business requirements for new systems and process improvements. Translate complex analytical findings and business needs into clear documentation and actionable strategies. Provide training and ongoing support to end-users on new systems, processes, and analytical tools. Report and Dashboard Development
Design, build, and maintain standard and ad-hoc operational reports and interactive dashboards using business intelligence tools (e.g., Power BI, Tableau). Requirements Gathering
Collaborate with stakeholders from clinical operations, finance, and other departments to gather business requirements for new reports and analytical projects. Data Integration and Quality
Extract, integrate, and validate data from multiple sources, including claims, membership, and provider data. Conduct root-cause analysis of data irregularities and ensure data accuracy. Communication of Insights
Interpret complex data findings and effectively communicate insights and recommendations to both technical and non-technical audiences through clear visualizations and presentations. Automation
Automate recurring reporting processes and workflows to improve statistical efficiency and free up resources for more complex analysis. Required Qualifications
5-7+ years of experience in a data analyst role, preferably within the healthcare or health insurance industry with payment integrity, i.e. medical and payment policies. 2-3 years analyzing claim editing rules for identification of trends. Demonstrated proficiency in SQL for querying and manipulating large datasets. Experience in developing reports and dashboards using data visualization tools like Microsoft Power BI, Tableau and QuickBase Tools. Experience with claims data, eligibility data, and medical and payment policy analytics. Knowledge of healthcare industry coding systems, including ICD-10 and CPT. Familiarity with data governance concepts and data management best practices. Education
Bachelor's degree in a quantitative field such as Statistics, Economics, Finance, Mathematics, or a healthcare-related discipline. Pay Range
$75,400.00 - $165,954.00 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. 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: 10/24/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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The Sr. Mgr. Business Analytics is responsible for developing, maintaining, and automating reports and dashboards that track the performance of medical and payment policies. By delivering data-driven insights to leadership and other stakeholders, this role helps optimize business processes, ensure policy compliance, and identify opportunities for efficiency improvements and cost savings. Data Analysis & Reporting
Extract, validate, and interpret large datasets from healthcare claims, authorizations, and payment systems. Conduct exploratory data analysis to identify patterns, trends, and deviations in payment or utilization. Evaluate medical and payment policy operations, identifying trends, patterns, and variances related to: Medical cost drivers and utilization patterns. Analyze effectiveness of medical and pre-payment policies, and precertification for delivery of insights on performance to leadership. Operational efficiency metrics, such as turnaround times and productivity. Policy compliance and adherence to regulatory requirements. Policy Quality & Compliance
Review payment policies and procedures for accuracy, identifying gaps and potential inaccuracies. Ensure adherence to medical policies and regulatory requirements, such as federal and state legislation and HIPAA. Participate in the design and deployment of algorithms or automated edits to ensure correct payment and prevent overpayments. Business Process & System Improvement
Collaborate with stakeholders to gather business requirements for new systems and process improvements. Translate complex analytical findings and business needs into clear documentation and actionable strategies. Provide training and ongoing support to end-users on new systems, processes, and analytical tools. Report and Dashboard Development
Design, build, and maintain standard and ad-hoc operational reports and interactive dashboards using business intelligence tools (e.g., Power BI, Tableau). Requirements Gathering
Collaborate with stakeholders from clinical operations, finance, and other departments to gather business requirements for new reports and analytical projects. Data Integration and Quality
Extract, integrate, and validate data from multiple sources, including claims, membership, and provider data. Conduct root-cause analysis of data irregularities and ensure data accuracy. Communication of Insights
Interpret complex data findings and effectively communicate insights and recommendations to both technical and non-technical audiences through clear visualizations and presentations. Automation
Automate recurring reporting processes and workflows to improve statistical efficiency and free up resources for more complex analysis. Required Qualifications
5-7+ years of experience in a data analyst role, preferably within the healthcare or health insurance industry with payment integrity, i.e. medical and payment policies. 2-3 years analyzing claim editing rules for identification of trends. Demonstrated proficiency in SQL for querying and manipulating large datasets. Experience in developing reports and dashboards using data visualization tools like Microsoft Power BI, Tableau and QuickBase Tools. Experience with claims data, eligibility data, and medical and payment policy analytics. Knowledge of healthcare industry coding systems, including ICD-10 and CPT. Familiarity with data governance concepts and data management best practices. Education
Bachelor's degree in a quantitative field such as Statistics, Economics, Finance, Mathematics, or a healthcare-related discipline. Pay Range
$75,400.00 - $165,954.00 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. 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: 10/24/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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