Lead Director- Informatics Reporting

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

A Brief Overview

The Lead Director – Informatics is responsible for defining and executing the data and reporting strategy for the Grievances & Appeals (G&A) organization, enabling timely, accurate, and actionable insights to improve operational efficiency, compliance, and decision-making. This role builds internal analytics capabilities, strengthens reporting processes, and develops a high-performing team.

What You Will Do:

Reporting Strategy & Execution

• Manages and optimizes Informatics reporting processes, systems, and strategies to provide accurate and timely information to key stakeholders.

• Provides strategic leadership in the development and execution of reporting strategies aligned with the organization's goals.

• Oversees the selection, implementation, and maintenance of reporting systems, schedules, and infrastructure.

• Evaluates and recommends appropriate reporting tools, databases, and platforms to support efficient and accurate reporting processes.

• Collaborates with stakeholders to identify reporting needs and requirements, design and create meaningful visualizations, and ensure data accuracy and consistency.

• Establishes and enforces reporting governance frameworks, policies, and procedures by ensuring compliance with relevant regulations, such as data privacy, security, and industry standards.

• Identifies opportunities to enhance reporting efficiency, accuracy, and usability through automation, data visualization, and self-service reporting capabilities.

• Establishes performance metrics and reporting mechanisms to assess the effectiveness of reporting initiatives.

• Act as a bridge between IT delivery, enterprise analytics, and clinical/Operational leadership to ensure risk management and regulatory compliance needs.

Advanced Analytics & Insights

• Leads teams of data analysts and specialists to analyze core G&A data and generate actionable insights.

• Enables visibility into:

  • Appeals turnaround time

  • Overturn reduction drivers

  • Grievance trends

  • Root cause analysis

  • Regulatory performance metrics

  • Productivity Metrics

• Drives proactive insights for operational improvement and compliance readiness.

Governance, Compliance & Quality

• Ensures adherence to healthcare regulations and audit requirements specific to grievances and appeals.

• Maintains high standards of data integrity, traceability, and auditability.

• Aligns reporting practices with enterprise data governance standards.

Internal Capability Development

• Builds in-house informatics and analytics capabilities to reduce reliance on external teams.

• Establishes scalable operating models, reusable data assets, and self-service solutions.

• Drives continuous improvement through automation and standardization.

Team Leadership & Development

• Creates robust job functions and role clarity within the informatics team.

• Leads, mentors, and develops talent across analytics, reporting, and domain expertise.

• Promotes a growth mindset, agility, and continuous learning culture.

Healthcare Domain Focus (Critical)

• Applies deep expertise in:

  • Healthcare claims, grievances, authorization and appeals processes

  • Appeals lifecycle management and compliance tracking

• Ensures data and reporting enable regulatory compliance, audit readiness, and operational excellence.

Required Qualifications:

• 10+ years of experience in informatics, analytics, or business intelligence

• Strong healthcare domain experience, preferably in: Claims, grievances, authorization and appeals

• Demonstrated leadership in data strategy, reporting, and team development

Preferred Qualifications:

• Experience i