Sr Manager, Business Intelligence

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary:

We are seeking a Business Intelligence / Cloud Development and Reporting Operations Sr Manager, within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities not limited to, reconciliation and aggregation, and financial and operational reporting.  We are seeking someone to design, develop, and optimize cloud-based solutions along with proven SQL and Python skills.  The ideal candidate will have expertise in AWS technologies such as Glue, S3, Athena and Quicksight, along with experience in data modeling, analytics, problem-solving and decision support. Experience with other cloud platforms such as GCP or Azure, as well as dashboard tools like Tableau or Power Bi is an added advantage. This role requires a self-starter with strong communication skills, capable of working in a fast-paced environment and collaborating across teams to deliver impactful solutions. Healthcare industry knowledge is required.

Overview / Key responsibilities:

• Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support MA Risk Adjustment Revenue Integrity initiatives.

• Responsible for leading the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps within the process, and leading to develop more efficiency within the process. 

• Act as business lead for system design and in testing new functions, as well as the support of auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects. 

• Drive change related to enhancements and system fixes.  Understanding interdependencies in both process and timing to further business objectives.  To be successful, the candidate will use their knowledge and experience to create meaning from the data.

• This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place.  You will be responsible for auditing tasks including documenting and evaluating critical controls.  You will be responsible for understanding procedures, results, and business impacts; and document and express such understanding in both written and verbal form. 

• Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs. 

• Tightly managing vendor data quality and timeliness; ensure data is ingested into CREW to drive submissions; any and all CREW validation errors are worked timely to ensure submission completeness; analyze and understand digital retrieval to maximize results; customize MA and ACA reporting views and outreach manager data needed for day to day operations work.

• Implement Python or PySpark solutions for data transformation and analytics.

• Write and optimize complex SQL queries for efficient data extraction, transformation, processing, and analysis.

• Build, optimize, and maintain AWS QuickSight and Tableau dashboards for data visualization and reporting.

• Ensure data integrity, validation, and compliance with healthcare industry standards and regulations.

• Document processes, technical designs, and best practices for future reference.

• Work in an Agile development environment, collaborating with cross-functional teams.

• Mentor junior team members and provide guidance on best practices in development, data analysis, reporting accuracy, and data validation.

Required Qualifications:

• 5+ years of experience in reporting and data analytics/informatics in a healthcare, Health insurance or similarly regulated environment

• 5+ years of experience with Python/SQL server in data analytics and manipulation.

• 5+ years of experience with BI tools, including Tableau, Quicksight, PowerBI.

• Strong proficiency in SQL for data manipulation and analytics.

• Hands-on experience with data visualization with AWS QuickSight or similar tools.

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