[Hiring] Manager - Medical Policy Business Analytics @CVS Health

Role Description

The Manager, Medical Policy Business Analytics is responsible for managing analytics, reporting, performance measurement, and operational intelligence activities that support Medical Policy and Payment Integrity functions. This role translates healthcare, claims, policy, utilization, and operational data into actionable insights that help inform business decisions, monitor performance, improve operational quality, support affordability initiatives, and strengthen compliance readiness.

The position partners with Clinical Operations, Medical Policy, Payment Integrity, Technology, Finance, Compliance, Quality, and Enterprise Reporting teams to identify opportunities for improvement, support policy governance activities, monitor key performance indicators, and deliver practical data-driven recommendations.

The Manager supports day-to-day analytical work, dashboard development, data validation, root cause analysis, performance monitoring, and business intelligence activities while ensuring deliverables are accurate, timely, and aligned with business priorities.

Key Accountabilities

• Medical Policy Performance Analytics (25%)
  • Manage the development and maintenance of performance reporting for Medical Policy, Payment Integrity, and related operational programs.
  • Develop, maintain, and monitor scorecards, key performance indicators (KPIs), and trend analyses.
  • 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 clear summaries, dashboards, and presentation materials for leadership review.
• Business Intelligence & Reporting Solutions (20%)
  • Oversee the design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions.
  • Provide subject matter input on reporting and business intelligence tools and support consistent use of reporting standards.
  • Partner with data management and technology teams to improve data accessibility and reporting capabilities.
  • Support delivery of accurate, timely, and actionable reporting for business partners and leadership stakeholders.
  • Promote self-service analytics and reporting capabilities where appropriate.
• Policy Governance, Compliance & Quality Monitoring (15%)
  • Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements.
  • Support policy governance committees through reporting, trend analysis, and metric development.
  • Partner with Quality Assurance and Compliance teams to identify and mitigate operational risks.
  • Support internal audits, regulatory reviews, corrective action plans, and remediation efforts.
• Business Process Improvement & Operational Excellence (15%)
  • Conduct root cause analyses to identify drivers of defects, policy exceptions, rework, and operational inefficiencies.
  • Support continuous improvement initiatives targeting quality enhancement, defect reduction, and process optimization.
  • Develop performance improvement recommendations supported by quantitative analysis.
  • Measure and monitor outcomes associated with process improvement initiatives.
• Business Requirements & Strategic Initiatives (10%)
  • Partner with business stakeholders to gather and document reporting, analytics, and operational requirements.
  • Support BRD development and translation of business needs into technical solutions.
  • Support strategic initiatives, system implementations, and transformation efforts by providing analytics, reporting, and business requirements input.
  • Ensure analytics solutions align with business objectives and operational priorities.
• Stakeholder Engagement & Project Coordination (10%)
  • Coordinate cross-functional workgroups, projects, and analytical initiatives to support business objectives.
  • Present insights, risks, trends, and recommendations to business leaders and cross-functional stakeholders.
  • Provide consultative support regarding healthcare analytics, reporting methodologies, and performance measurement approaches.
  • Build strong partnerships across clinical, operational, technology, compliance, and finance organizations.
• Data Quality & Governance (5%)
  • Support reporting standards and data governance practices.
  • Ensure data integrity, consistency, and reliability across analytics platforms.
  • Support data validation, quality monitoring, and issue remediation activities.
  • Maintain documentation related to reporting methodologies, metric definitions, and data sources.

Qualifications

• 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 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.

Preferred Qualifications

• Knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations.
• Experience supporting enterprise governance committees and executive leadership reporting.
• Experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows.
• Experience supporting transformation, automation, and operational improvement initiatives.
• Experience supporting audit readiness, regulatory reviews, and control monitoring programs.
• Knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques.

Education

• Bachelor's Degree or equivalent experience.

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.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Company Description

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.