Manager – Medical Policy Business Analytics

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Oversee analytics, reporting, performance measurement, and operational intelligence functions that support Medical Policy and Payment Integrity.

• Convert healthcare, claims, policy, utilization, and operational data into practical insights.

• Create and manage performance reports, scorecards, KPIs, and trend analyses.

• Evaluate policy performance, utilization trends, coding patterns, financial results, and operational efficiency.

• Compile summaries, dashboards, and presentation materials for review by leadership.

• Supervise the design, development, automation, and upkeep of dashboards, scorecards, and analytical reporting solutions.

• Collaborate with data management and technology teams to enhance data accessibility and reporting capabilities.

• Track policy compliance, implementation success, and adherence to internal controls and regulatory standards.

• Assist governance committees, internal audits, regulatory assessments, corrective action plans, and remediation activities.

• Perform root cause analyses and aid in continuous improvement, defect reduction, and process optimization efforts.

• Collect and document reporting, analytics, and operational needs; assist in BRD development and its translation into technical solutions.

• Contribute to strategic initiatives, system implementations, and transformation projects.

• Organize cross-functional workgroups, projects, and analytical efforts.

• Share insights, risks, trends, and recommendations with leaders and stakeholders.

• Assist in data governance, validation, quality monitoring, issue remediation, and the documentation of reporting methodologies, metric definitions, and data sources.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare domains.

• At least 4 years of experience leading or coordinating projects, analytical workflows, reporting initiatives, or cross-functional business activities.

• Advanced analytical, quantitative, and problem-solving abilities utilizing AI.

• Proven experience in creating executive dashboards, scorecards, KPIs, and performance reporting.

• Familiarity with trend analysis, forecasting, root cause analysis, and performance measurement.

• Capable of coordinating analytical work, managing competing priorities, and influencing stakeholders in a matrixed environment.

• Ability to juggle daily operational tasks with long-term business objectives.

• Proficient in conveying complex analytical concepts to both technical and non-technical audiences.

• Strong skills in stakeholder management and relationship building.

• Advanced proficiency in Microsoft Excel.

• Experience with tools such as Power BI, Tableau, SQL, SAS, Snowflake, Azure Analytics, or similar platforms.

• A Bachelor's Degree or equivalent experience.

• Preferred: Familiarity with medical and payment policy configuration, claims editing, adjudication processes, and end-to-end claims operations.

• Preferred: Experience in supporting enterprise governance committees and reporting for executive leadership.

• Preferred: Experience in developing business requirements documents (BRDs), process maps, user stories, and operational workflows.

• Preferred: Background in supporting transformation, automation, and operational improvement initiatives.

• Preferred: Experience in ensuring audit readiness, regulatory reviews, and monitoring control programs.

• Preferred: Knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources promoting physical, emotional, and financial wellness

• Eligibility for CVS Health bonus, commission, or short-term incentive programs