Position SummaryWe are expanding the Medicare strategy and insights team to support provider enablement activities. This position will serve as subject matter expert on Medicare Risk Adjustment at-risk provider reporting and will be responsible for tracking and analyzing risk adjustment activities and performance at provider group and Group sponsor level. They will collaborate closely with Revenue Integrity Provider Optimization and Excellence (RIPOE) to create best-in-class at-risk provider enablement initiatives.
Responsibilities.
- Develop and Maintain analytical tools to support RIPOE activities.
Specifics:
- Design and develop analytical solutions leveraging GCP, AWS, Databricks, SAS, SQL, and related cloud technologies to support Medicare Informatics initiatives.
- Create scalable data assets and reporting frameworks utilizing modern cloud-based data platforms and data engineering best practices.
- Develop analytical tools including membership trend, Risk score trend, chronic conditions and clinical tracking metrices.
- Provide ad-hoc analytic solutions to help business partners understand their problems and goals.
- Assist in creation of new health metrics and implementation.
- Build Provider Group (PBG/PBP/MSO) specific reporting for Engagement Managers
- Develop and publish internal/external reporting and communication with stakeholders for action plans
- Act as an analytics expert to translate business needs into strategic projects and actions.
- Develop and maintain MEU and Financial data assets, BI tools, and cloud-based analytical solutions using Databricks, GCP, AWS, and SAS to support at-risk provider reporting, reconciliation of RAPS/EDS, Medical Cost Funds, and overall performance management.
- Apply business rules to identify improvement opportunities in clinical coding and member engagement.
- Serve as a technical and analytics subject matter expert, providing guidance on cloud data platforms, advanced analytics methodologies, and reporting solutions.
- Partner with technology, data engineering, and business stakeholders to implement scalable analytic capabilities and data products.
Can work reside anywhere in the US. Sponsorship not available.
Required Qualifications- 5+ years' experience of design and coding efficiency in SAS, SQL, Python or similar programming language.
- 5+ years' experience leading the development of analytic solutions and initiatives with track record of business impact.
- skills
- Data analytics or business intelligence
- The dynamics of supporting a variety of stakeholders that serve the business
- Business integrity and accountability
- Working experience with member, claim, encounter, pharmacy, or diagnosis data
- Experience working with large sets of data and solving data challenges
- Effective reporting and communication
- Strong customer service skills
Ability To: - Be a self starter, staying curious and self solve for issues with little direction being mindful of strict deadlines
- Be comfortable with change
- Execute algorithms to solve business problems
- Interact with a variety of stakeholders
- Be very organized; attention to detail
- Motivated and willing to probe into technical details
- Learn and absorb quickly varying state rules and regulations
- Juggle multiple priorities successfully and pivoting to new solutions or processes if needed
Preferred Qualifications:- Government-regulated healthcare programs such as Commercial, Medicare or Medicaid
- Health insurance concepts and definitions
- Risk Adjustment (Commercial, Medicare or Medicaid)
- Population health analytics
- Prior experience working for a health plan
- Demonstrated experience in building business intelligence solutions and dashboards in Tableau, AWS or Python programming language.
- Risk score calculations
- Statistical modeling
- Reporting and visualization
Ability To:- Build automated end-to-end processes
EducationBachelors degree preferred or equivalent work experience preferred.
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe 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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/24/2026
