Senior Healthcare Data Analyst

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.Position SummaryThis role leads advanced analytics supporting Medicare and Risk Adjustment programs, with a focus on driving accurate risk score capture (RAF), improving performance against CMS benchmarks, and supporting enterprise risk-adjustment strategies. The analyst partners closely with clinical, coding, finance, operations, and compliance stakeholders to translate complex Medicare data into actionable insights.Key ResponsibilitiesLead analytical initiatives supporting Medicare and CMS Risk Adjustment programsAnalyze large healthcare datasets (claims, encounters, enrollment, chart reviews, and clinical data) to: Identify RAF optimization opportunitiesMonitor coding accuracy and completenessAssess financial and operational impact of risk score changesDevelop and maintain SQL-based data pipelines and analytic models in large data warehouse environmentsProduce executive-level reporting and dashboards addressing: HCC performanceCoding gap closureSuspect and recapture outcomesProvider and member impactTranslate CMS regulations, risk adjustment models, and technical findings into clear business insightsPartner with coding, clinical, compliance, and operational leaders to support risk-adjustment initiativesServe as a subject matter expert on Medicare data, metrics, and CMS standardsLead or support analytic projects end-to-end, including scope definition, analysis, and stakeholder deliveryRequired QualificationsBachelor's degree in Statistics, Mathematics, Economics, Computer Science, Actuarial Science, Healthcare, or a related field3+ years advanced SQL expertise in enterprise data warehouse or big-data environments3+ years experience with healthcare analytics, including large, complex datasetsExperience developing reports and visualizations using tools such as Tableau, Power BI, or Microsoft AccessStrong understanding of relational databases and healthcare data structures (claims, encounters, member, provider)Demonstrated ability to clearly communicate statistical and technical results to non-technical audiencesProven analytical problem-solving and critical-thinking skillsExperience collaborating across multidisciplinary healthcare teamsPreferred QualificationsDirect experience with Medicare and Risk Adjustment, including: CMS-HCC modelsRAF calculationsCoding gap or suspect analysisMaster's degree in a quantitative or healthcare-related disciplineExperience in health plan or provider environmentsBackground in: Multivariate statistical modelingHealth economics or outcomes researchPredictive modeling or data miningFamiliarity with CMS regulations, submission processes, and audit conceptsPrior project leadership or team lead experienceStrong understanding of healthcare data standards, quality measures, and compliance considerationsEducationBachelor's degree or equivalent work experience.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $112,200.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 06/02/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.J-18808-Ljbffr