Manager, Risk Adjustment Informatics

CVS Health

. Develop, enhance, automate, and maintain standardized monthly program evaluation and KPI reporting using claims, enrollment, diagnosis, provider, and risk adjustment data .

Posted 10/13/2026full-timeRemote • Washington • United StatesMid-LevelSenior💰 $66,330 - $145,860 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare analytics, data management, and risk adjustment methodologies, with a strong focus on developing automated reporting and data pipelines in cloud environments. Proficient in Python, SQL, and managing healthcare datasets to support program evaluation and performance measurement.

Highest-signal resume keywords

Healthcare AnalyticsSQL Query DevelopmentPython ProgrammingRisk Adjustment ModelsCloud-Based Data Solutions

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data ManagementAutomated ReportingData Pipeline DevelopmentHealthcare ValuationRisk Adjustment EconomicsStatistical AnalysisData Quality MonitoringKPI ReportingComplex Problem SolvingData Validation

Soft Skills

CommunicationCollaborationStakeholder EngagementLeadershipIssue Resolution

Tools & Technologies

Google Cloud PlatformBigQueryDatabricksAWSGitHubSAS

Industry Keywords

Medicare AdvantageACA Risk AdjustmentHealthcare ClaimsEnrollment DataProvider Performance MeasurementHealthcare Finance

Tech Stack

Tools & technologies

AWSBigQueryCloudGoogle Cloud PlatformPythonSQL

About the role

Key responsibilities & impact

Develop, enhance, automate, and maintain standardized monthly program evaluation and KPI reporting using claims, enrollment, diagnosis, provider, and risk adjustment data
Develop and maintain member-level risk adjustment datasets, risk score files, and analytical outputs for Medicare Advantage and ACA programs
Maintain, validate, enhance, and document CMS risk adjustment models in Python and Databricks
Design, develop, and maintain cloud-based datasets, automated data pipelines, and analytical infrastructure within Google Cloud Platform, BigQuery, Databricks, AWS, and Python environments
Develop, automate, and streamline processes for sharing risk adjustment valuation data, reporting outputs, and reference datasets
Lead and support migration of analytic processes and data assets from SAS to cloud-based solutions
Monitor data quality, identify root causes of issues, and implement sustainable solutions with stakeholders
Own and support recurring monthly and ad hoc production processes, including monitoring, quality control, troubleshooting, issue resolution, and documentation
Maintain and improve reference datasets, business rules, and metadata supporting risk adjustment models, valuation processes, KPI reporting, and program analytics
Partner with Informatics, Revenue Integrity, Actuarial, PMO, Data Engineering, and other stakeholders to gather requirements and deliver scalable analytical solutions
Research and respond to complex ad hoc questions related to risk adjustment program performance, valuation methodologies, and healthcare financial outcomes

Requirements

What you’ll need

5+ years of experience in healthcare analytics, data management, data engineering, reporting, or business analytics
3+ years of experience writing complex SQL queries in cloud-based environments such as BigQuery, Databricks, AWS, or similar platforms
Experience developing and supporting automated reporting, production processes, or data pipelines
Experience using GitHub or other source control tools to manage code repositories and version control
Experience working with healthcare claims, enrollment, provider, diagnosis, finance, or risk adjustment data
Ability to communicate technical concepts to technical and non-technical stakeholders
Experience leading or supporting large-scale modernization and migration initiatives
3+ years of experience with Python, SAS, or equivalent data engineering/analytics programming languages
Experience with Medicare Advantage and/or ACA Risk Adjustment
Experience implementing, maintaining, validating, or reconciling CMS risk adjustment models
Experience developing and maintaining member-level healthcare datasets or other large-scale healthcare data assets
Experience with healthcare valuation, medical economics, risk adjustment economics, provider performance measurement, or healthcare finance concepts
Bachelor's degree in Analytics, Informatics, Statistics, Mathematics, Computer Science, Healthcare Administration, Economics, Finance, or equivalent work experience

Benefits

Comp & perks

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