Lead Director – Performance Analytics, Optimization

This is a fully remote position, open to applicants in Alabama, +20 more states.

📋 Description

• Create and uphold a standardized performance measurement framework across Payment Integrity editing platforms.

• Track edit performance throughout the entire edit lifecycle.

• Design and sustain KPIs, performance scorecards, Power BI dashboards, and executive reports.

• Evaluate trends in claims, savings, utilization, provider behavior, and edit results.

• Recognize edits that are underperforming, overperforming, anomalous, inaccurate, or have a high rate of false positives.

• Set performance thresholds, quality standards, sampling methodologies, and monitoring practices.

• Deliver executive-level reporting and insights to Payment Integrity leadership.

• Independently assess and validate edit savings.

• Compare expected savings to realized savings and pinpoint financial performance variances.

• Collaborate with Finance and Payment Integrity leadership on savings methodologies.

• Discover opportunities to enhance savings realization through optimization.

• Offer objective feedback to editing and solution design teams.

• Work alongside editing teams on optimization strategies.

• Balance financial opportunities with edit accuracy, provider experience, and operational efficiency.

• Establish and oversee continuous optimization and post-deployment review processes.

• Formulate data-driven optimization recommendations and prioritize tasks based on financial impact, quality, risk, and operational value.

• Monitor recommendations until completion and assess the resulting impact.

• Supervise centralized performance reporting for Payment Integrity editing.

⛳️ Requirements

• Over 5 years of progressive experience in healthcare, Payment Integrity, claims, analytics, data, operations, or a related field.

• More than 5 years of leadership experience managing teams and/or complex enterprise programs.

• Proven experience leading analytics-driven performance management.

• Experience handling large, complex datasets and converting data into business decisions.

• Background in developing executive dashboards and performance reporting.

• Familiarity with healthcare claims data and payment integrity is highly preferred.

• Experience with claims editing, prepay/post-pay processes, or claims platforms is strongly preferred.

• Demonstrated experience with continuous improvement and optimization methodologies.

• A Bachelor’s degree in Business, Analytics, Data Science, Healthcare Administration, Finance, Information Systems, or equivalent work experience is required.

🏝️ Benefits

• CVS Health bonus, commission or short-term incentive program.

• Award target in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Other resources supporting physical, emotional, and financial well-being.