Manager – Medical Policy Business Reporting

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

📋 Description

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

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

• Direct the development and upkeep of performance reporting, scorecards, KPIs, and trend analyses.

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

• Create summaries, dashboards, and presentation materials for leadership review.

• Supervise the design, development, automation, and maintenance 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 effectiveness, internal controls, and adherence to regulatory standards.

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

• Perform root cause analyses and promote continuous improvement, defect reduction, and process optimization.

• Collect and document reporting, analytics, and operational requirements; assist with BRD development and technical solution translation.

• Aid strategic initiatives, system implementations, transformation efforts, and business requirements activities.

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

• Present insights, risks, trends, and recommendations to business leaders and cross-functional stakeholders.

• Support data governance, validation, quality monitoring, issue resolution, and 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 functions.

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

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

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

• Proficient in trend analysis, forecasting, root cause analysis, and performance measurement.

• Capability to coordinate analytical work, manage competing priorities, and influence stakeholders in a matrixed environment.

• Ability to balance daily operational priorities with long-term business objectives.

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

• Strong stakeholder management and relationship-building capabilities.

• Advanced proficiency in Microsoft Excel.

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

• Bachelor's Degree or equivalent experience.

• Preferred: Understanding of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations.

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

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

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

• Preferred: Experience in preparing for audits, regulatory reviews, and control monitoring 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 supporting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive program in addition to base pay.