Manager – MPPS Policy Business Analytics

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

📋 Description

• Oversee analytics, reporting, performance measurement, and operational intelligence efforts related to Medical Policy and Payment Integrity.

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

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

• Discover opportunities to enhance affordability, quality, and operational efficiency through insights derived from data.

• Prepare 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 adherence to policies, effectiveness of implementation, compliance, internal controls, and regulatory standards.

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

• Perform root cause analyses and support initiatives for continuous improvement, defect reduction, and process optimization.

• Formulate recommendations for performance improvement and monitor the outcomes of initiatives.

• Collect and document requirements related to reporting, analytics, and operations.

• Aid in the development of Business Requirements Documents (BRDs), system implementations, strategic initiatives, and transformation efforts.

• Coordinate cross-functional teams, projects, and analytical initiatives.

• Deliver insights, risks, trends, and recommendations to leaders and stakeholders.

• Support data governance, validation, quality monitoring, issue resolution, and the documentation of reporting methodologies, metrics, and data sources.

⛳️ Requirements

• At least 5 years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare roles.

• Minimum of 2 years of experience leading or coordinating projects, analytical workstreams, reporting initiatives, or cross-functional business activities.

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

• Proficient in developing executive dashboards, scorecards, KPIs, and performance reports.

• Experience conducting trend analyses, forecasting, root cause analyses, and performance measurement.

• Skilled in coordinating analytical tasks, managing competing priorities, and influencing stakeholders in a matrixed environment.

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

• Capacity to convey complex analytical ideas to both technical and non-technical audiences.

• Strong skills in stakeholder management and relationship-building.

• Advanced proficiency in Microsoft Excel.

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

• Preferred knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and comprehensive claims operations.

• Experience in supporting enterprise governance committees and reporting for executive leadership is preferred.

• Familiarity with developing business requirements documents (BRDs), process maps, user stories, and operational workflows is preferred.

• Experience in supporting transformation, automation, and operational improvement initiatives is preferred.

• Experience in supporting audit readiness, regulatory reviews, and control monitoring programs is preferred.

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

• Bachelor’s Degree or equivalent experience.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.