[Hiring] Manager, Informatics @CVS Health

Role Description

The Informatics Manager designs and executes claim operational analysis, creating insight into the Medical and Dental claim operational environments for Aetna actuaries, Service Operations Leadership, Compliance, Market leads, and production teams. The Consultant evaluates the operational and financial flow of claims throughout the claim lifecycle, across multiple claim systems, and includes:

• Monitoring normal flow
• Identifying and quantifying topics of concern

The position also builds information resources to support tactical operational needs, fulfills requests for operational data, and performs a variety of analysis to support Service Operations' needs. As a member of our Claim Operations Analytics team, you'll have the opportunity to learn as you provide valuable information to decision-makers.

Qualifications

• 3+ years’ experience using SAS, BigQuery, SQL, Python, or similar query language, to extract, transform, process, and summarize large datasets
• 2+ years performing large scale analysis on medical claim operational (i.e., non-clinical) data, such as auto-adjudication rates, turnaround times, payment patterns, inventory composition, denial rates, etc.
• Demonstrated business knowledge of the medical claim lifecycle (Claim Intake, Adjudication, Editing, Pend/Inventory management, Payment, Appeals, Rework)
• Demonstrated ability to manage multiple projects simultaneously
• Experience performing data 'quality and reasonableness' testing on claim operational data
• Strong Excel skills, including mastery of logical & text functions, pivot tables
• Experience applying logic and critical thinking to solve business problems involving operational data
• Experience turning data into information
• Excellent written communication skills

Requirements

• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: $66,330.00 - $145,860.00

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• 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