Senior Healthcare Data Analyst

CVS Health® is committed to building a more connected and compassionate health experience. The Senior Healthcare Data Analyst will lead advanced analytics supporting Medicare and Risk Adjustment programs, focusing on driving accurate risk score capture and improving performance against CMS benchmarks.

Responsibilities:

• Lead analytical initiatives supporting Medicare and CMS Risk Adjustment programs
• Analyze large healthcare datasets (claims, encounters, enrollment, chart reviews, and clinical data) to:
• Identify RAF optimization opportunities
• Monitor coding accuracy and completeness
• Assess financial and operational impact of risk score changes
• Develop and maintain SQL‑based data pipelines and analytic models in large data warehouse environments
• Produce executive‑level reporting and dashboards addressing:
• HCC performance
• Coding gap closure
• Suspect and recapture outcomes
• Provider and member impact
• Translate CMS regulations, risk adjustment models, and technical findings into clear business insights
• Partner with coding, clinical, compliance, and operational leaders to support risk‑adjustment initiatives
• Serve as a subject matter expert on Medicare data, metrics, and CMS standards
• Lead or support analytic projects end‑to‑end, including scope definition, analysis, and stakeholder delivery

Requirements:

• Bachelor's degree in Statistics, Mathematics, Economics, Computer Science, Actuarial Science, Healthcare, or a related field
• 3+ years advanced SQL expertise in enterprise data warehouse or big‑data environments
• 3+ years experience with healthcare analytics, including large, complex datasets
• Experience developing reports and visualizations using tools such as Tableau, Power BI, or Microsoft Access
• Strong understanding of relational databases and healthcare data structures (claims, encounters, member, provider)
• Demonstrated ability to clearly communicate statistical and technical results to non‑technical audiences
• Proven analytical problem‑solving and critical‑thinking skills
• Experience collaborating across multidisciplinary healthcare teams
• Direct experience with Medicare and Risk Adjustment, including: CMS‑HCC models, RAF calculations, Coding gap or suspect analysis
• Master's degree in a quantitative or healthcare‑related discipline
• Experience in health plan or provider environments
• Background in: Multivariate statistical modeling, Health economics or outcomes research, Predictive modeling or data mining
• Familiarity with CMS regulations, submission processes, and audit concepts
• Prior project leadership or team lead experience
• Strong understanding of healthcare data standards, quality measures, and compliance considerations