Senior Analyst, Provider Compliance

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.

About the Role

We are seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. In this role, you will lead strategic initiatives that ensure accurate, timely, and high-quality audit results, strengthen regulatory relationships, and implement proactive measures to mitigate risk. You’ll partner cross-functionally to optimize audit results and implement preventative measures to mitigate risk, while influencing best practices that enhance operational efficiency and compliance. If you are a proactive problem solver with strong leadership skills and a passion for delivering sustainable, compliant solutions, we want to hear from you.

Position Summary
Leads and ensures the delivery of high-quality internal and external Medicaid provider audit results, regulatory compliance activities, and proactive risk mitigation strategies. Applies deep expertise in compliance, business operations, analytics, and communication to develop and execute strategies that support regulatory and contractual obligations. Partners cross-functionally to support accurate, complete, and timely audit and regulatory deliverables, standardize processes, optimize workflows, and enable data integrity across the organization. Drives and supports provider compliance initiatives that promote consistency, accuracy, compliance, and operational excellence.

The ideal candidate is a strategic, solutions-oriented leader with strong analytical and communication skills, capable of influencing outcomes and implementing best practices that enhance audit performance, regulatory relationships, and operational efficiency. This role requires technical acumen, critical thinking, and the ability to lead complex initiatives in a dynamic environment.

Key Responsibilities

• Direct and foster best-in-class collaboration with internal teams and external auditors to deliver quality results, ensure continuous improvement, and maintain compliance.
• Interpret audit findings to recommend sustainable corrective actions and process improvements that mitigate risk.
• Support the response to complex inquiries from internal stakeholders and regulators with accuracy, timeliness, and completeness.
• Serve as a technical and functional leader, managing multiple compliance-related projects and deliverables to ensure timely execution and desired outcomes.
• Oversee policy and procedural documentation development and the timeliness of required annual reviews.
• Build and sustain productive partnerships across all organizational levels; exercise sound judgment, remove barriers, and influence ethical, compliant outcomes to achieve strategic goals.

Required Qualifications

• Minimum of 3 years of progressive experience in audit, compliance, or related healthcare operations.
• Proven ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives successfully.
• Strong analytical skills with demonstrated ability to interpret data, identify trends, and recommend actionable solutions for compliance-related challenges.
• Experience with Microsoft Excel with advanced proficiency for data analysis and reporting to strengthen internal controls and mitigate risk.
• Exceptional ability to convey complex information clearly and concisely, build relationships across organizational levels, and influence decision-making.
• Ability to lead initiatives, mentor team members, and thrive in a fast-paced, evolving environment while maintaining compliance and quality standards.

Preferred Qualifications

• 5 years of progressive experience in audit, compliance, or related healthcare operations.
• Ability to interpret and apply business knowledge to implement state and federal laws and regulations impacting healthcare operations.
• Three or more years of demonstrated success leading audits, complex projects, ensuring timely delivery, and driving measurable outcomes.
• Three or more years of experience managing provider data operations, including compliance.
• Three or more years of experience in network management, contracting, or related healthcare network functions.
• One or more years of hands-on experience with provider data management platforms.

Education