Manager – Medical Policy Business Analytics

CVS Health

. Manage analytics, reporting, performance measurement, and operational intelligence activities supporting Medical Policy and Payment Integrity functions .

Posted 10/8/2026full-timeRemote • Missouri • United StatesMid-LevelSenior💰 $54,300 - $145,860 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare analytics, performance measurement, and operational intelligence, with a strong focus on developing dashboards, KPIs, and actionable insights. Proficient in stakeholder management and communication of complex analytical concepts to diverse audiences.

Highest-signal resume keywords

Healthcare AnalyticsPerformance ReportingAdvanced Microsoft ExcelPower BISQL

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisTrend AnalysisRoot Cause AnalysisForecastingPerformance MeasurementQuantitative Problem-SolvingBusiness Requirements DocumentationProcess OptimizationOperational EffectivenessCompliance Monitoring

Soft Skills

Stakeholder ManagementRelationship BuildingCommunication SkillsProject CoordinationInfluencing Skills

Tools & Technologies

Power BITableauSASSnowflakeAzure Analytics

Industry Keywords

Medical PolicyPayment IntegrityHealthcare OperationsClaims EditingAdjudication WorkflowsData GovernanceRegulatory ComplianceContinuous ImprovementDefect ReductionOperational Workflows

Tech Stack

Tools & technologies

AzureSQLTableau

About the role

Key responsibilities & impact

Manage analytics, reporting, performance measurement, and operational intelligence activities supporting Medical Policy and Payment Integrity functions
Translate healthcare, claims, policy, utilization, and operational data into actionable insights
Develop and maintain performance reporting, scorecards, KPIs, and trend analyses
Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness
Prepare summaries, dashboards, and presentation materials for leadership review
Oversee design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions
Partner with data management and technology teams to improve data accessibility and reporting capabilities
Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements
Support governance committees, internal audits, regulatory reviews, corrective action plans, and remediation efforts
Conduct root cause analyses and support continuous improvement, defect reduction, and process optimization
Gather and document reporting, analytics, and operational requirements; support BRD development and translation into technical solutions
Support strategic initiatives, system implementations, and transformation efforts
Coordinate cross-functional workgroups, projects, and analytical initiatives
Present insights, risks, trends, and recommendations to leaders and stakeholders
Support data governance, validation, quality monitoring, issue remediation, and documentation of reporting methodologies, metric definitions, and data sources

Requirements

What you’ll need

5+ years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare functions
4+ years of experience leading or coordinating projects, analytical workstreams, reporting initiatives, or cross-functional business activities
Advanced analytical, quantitative, and problem-solving skills leveraging AI
Experience developing executive dashboards, scorecards, KPIs, and performance reporting
Experience with trend analysis, forecasting, root cause analysis, and performance measurement
Ability to coordinate analytical work, manage competing priorities, and influence stakeholders across a matrixed environment
Ability to balance day-to-day operational priorities with longer-term business goals
Ability to communicate complex analytical concepts to technical and non-technical audiences
Strong stakeholder management and relationship-building skills
Advanced Microsoft Excel skills
Experience with Power BI, Tableau, SQL, SAS, Snowflake, Azure Analytics, or similar tools
Bachelor's Degree or equivalent experience
Preferred: knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations
Preferred: experience supporting enterprise governance committees and executive leadership reporting
Preferred: experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows
Preferred: experience supporting transformation, automation, and operational improvement initiatives
Preferred: experience supporting audit readiness, regulatory reviews, and control monitoring programs
Preferred: knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility