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:
We are seeking a Business Intelligence / Cloud Development and Reporting Operations Sr Manager, within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities not limited to, reconciliation and aggregation, and financial and operational reporting. We are seeking someone to design, develop, and optimize cloud-based solutions along with proven SQL and Python skills. The ideal candidate will have expertise in AWS technologies such as Glue, S3, Athena and Quicksight, along with experience in data modeling, analytics, problem-solving and decision support. Experience with other cloud platforms such as GCP or Azure, as well as dashboard tools like Tableau or Power Bi is an added advantage. This role requires a self-starter with strong communication skills, capable of working in a fast-paced environment and collaborating across teams to deliver impactful solutions. Healthcare industry knowledge is required.
Overview / Key responsibilities:
Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support MA Risk Adjustment Revenue Integrity initiatives.
Responsible for leading the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps within the process, and leading to develop more efficiency within the process.
Act as business lead for system design and in testing new functions, as well as the support of auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects.
Drive change related to enhancements and system fixes. Understanding interdependencies in both process and timing to further business objectives. To be successful, the candidate will use their knowledge and experience to create meaning from the data.
This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place. You will be responsible for auditing tasks including documenting and evaluating critical controls. You will be responsible for understanding procedures, results, and business impacts; and document and express such understanding in both written and verbal form.
Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs.
Tightly managing vendor data quality and timeliness; ensure data is ingested into CREW to drive submissions; any and all CREW validation errors are worked timely to ensure submission completeness; analyze and understand digital retrieval to maximize results; customize MA and ACA reporting views and outreach manager data needed for day to day operations work.
Implement Python or PySpark solutions for data transformation and analytics.
Write and optimize complex SQL queries for efficient data extraction, transformation, processing, and analysis.
Build, optimize, and maintain AWS QuickSight and Tableau dashboards for data visualization and reporting.
Ensure data integrity, validation, and compliance with healthcare industry standards and regulations.
Document processes, technical designs, and best practices for future reference.
Work in an Agile development environment, collaborating with cross-functional teams.
Mentor junior team members and provide guidance on best practices in development, data analysis, reporting accuracy, and data validation.
Required Qualifications:
5+ years of experience in reporting and data analytics/informatics in a healthcare, Health insurance or similarly regulated environment
5+ years of experience with Python/SQL server in data analytics and manipulation.
5+ years of experience with BI tools, including Tableau, Quicksight, PowerBI.
Strong proficiency in SQL for data manipulation and analytics.
Hands-on experience with data visualization with AWS QuickSight or similar tools.
Experience in data modeling and working with structured and unstructured datasets.
Strong problem-solving skills and ability to troubleshoot technical challenges.
Self-starter with the ability to work independently and take initiative.
Excellent communication skills to collaborate with technical and business stakeholders.
Experience working in an Agile development environment or similar methodologies.
Understanding of healthcare industry data and compliance requirements is a plus.
Preferred Qualifications:
7+ years of experience in reporting and data analytics/informatics in a healthcare, Health insurance or similarly regulated environment
Vendor management experience.
Experience with CMS Risk Adjustment programs.
7+ years of healthcare, health insurance, or relevant combination of experience.
7+ years of experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis strategic business planning, and/or risk management consulting.
Experience documenting business processes, as well as, recommending and implementing improvement strategies.
Participates in system design.
Experience with IT application development lifecycles, methodologies.
Strong problem-solving, analytical, critical thinking and project management skills.
Experience influencing others by turning data into meaningful and actionable information.
Ability to perform testing functions.
Ability to audit the accuracy of reporting against source documents/reports/databases.
Education
Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline or equivalent professional work experience.
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00
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.
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
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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: 07/11/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Top Skills
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners.
Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
