Lead Director, Risk Adjustment Performance Reporting and Insights

CVS Health

. Lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions .

Posted 9/21/2026full-timeRemote • United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare analytics, risk adjustment methodologies, and business intelligence solutions, with a strong focus on data storytelling, advanced visualizations, and predictive analytics. Proven leadership in managing analytics teams and driving performance improvement through strategic insights and stakeholder collaboration.

Highest-signal resume keywords

Healthcare AnalyticsBusiness IntelligenceSQL ProgrammingPower BILeadership Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Predictive AnalyticsData VisualizationRisk Adjustment MethodologiesPerformance MetricsData StorytellingAdvanced AnalyticsAutomationKPI DevelopmentBenchmarkingData Modeling

Soft Skills

Executive CommunicationStrategic ThinkingStakeholder ManagementTeam DevelopmentCollaboration

Tools & Technologies

TableauQuickSightAnalytics PlatformsSelf-Service Reporting ToolsInformatics

Certifications & Qualifications

Master’s DegreeProfessional Certification

Industry Keywords

MedicareMedicaidACAHCC ModelsHealthcare ClaimsCMS Regulatory RequirementsValue-Based CareProvider PerformanceOperational PlanningMarket Strategy

Tech Stack

Tools & technologies

PythonSQLTableau

About the role

Key responsibilities & impact

Lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions
Transform clinical, operational, and risk adjustment data into actionable insights for provider performance, program efficiency, and executive decision-making
Create action through data storytelling, advanced visualizations, AI, and automation
Provide thought leadership and vision partnership to Market leads, Finance, Clinical, and Operational partners
Provide technical guidance on BI tool input modeling and calculations
Deliver risk adjustment KPIs, trends, and performance drivers through dashboards and reporting tools
Quantify risk movement drivers and surface insights to business leaders
Assess performance against objectives through benchmarking and goal setting
Deliver executive insights and recommendations supporting market strategy, operational planning, and performance improvement
Develop and oversee provider performance analytics for gap closure, engagement, and risk adjustment outcomes
Monitor provider performance metrics, variation, trends, opportunities, and best practices
Partner with provider, clinical, and operational leaders on performance improvement and targeted interventions
Evaluate provider-facing risk adjustment programs, value-based care, point-of-care enablement solutions, and other initiatives
Lead adoption of AI, advanced analytics, automation, and modern business intelligence capabilities
Drive modernization of analytics platforms, data solutions, and self-service reporting tools
Use predictive analytics and data visualization to improve insight generation and forecasting
Partner with Informatics, Data Engineering, and IT teams on scalable analytics solutions
Establish KPI definitions, governance standards, and an enterprise analytics framework
Oversee analytics delivery priorities, intake management, work prioritization, resource allocation, and coordination
Lead, mentor, and develop an analytics and business intelligence team of approximately 4–5 direct reports and 7–8 employees overall
Partner with executive leaders across Risk Adjustment, Finance, Actuarial, Clinical, Provider, and IT organizations
Foster accountability, innovation, collaboration, and continuous learning

Requirements

What you’ll need

10+ years of healthcare analytics, informatics, performance insights, actuarial, value-based, or business intelligence experience
2+ years of leadership experience managing analytics, reporting, or business intelligence
Strong executive communication, strategic thinking, stakeholder management, and team development skills
Advanced experience and familiarity with programming languages such as SQL and Python
Experience with BI platforms such as Power BI, Tableau, and QuickSight
Proven ability to lead complex analytics portfolios, establish priorities, and maintain organization in developer code and processes
Bachelor’s degree or equivalent professional work experience
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements preferred
Experience at a health plan or provider system preferred
Master’s degree or equivalent advanced education, professional certification, or demonstrated subject matter expertise preferred

Benefits

Comp & perks

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