Healthcare Analytics Business Consultant, CVS Health

CVS Health

Location:
United States

Category:
IT - Software Development

Contract Type:
Employment contract

Salary:

54300.00 - 145860.00 USD / Year

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Job Description:

This is an individual contributor position for a Data Analyst in the Special Investigation Unit within a leading health insurance organization. The role focuses on transforming complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. The position can sit anywhere in the United States but must work East Coast hours.

Job Responsibility:

Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets
Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity
Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and standards
Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences
Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements
Develop and participate in presentation and consultation with business partners on data, capabilities and performance results
Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity
Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance

Requirements:

Minimum of 3 years of data interpretation and analysis experience, preferable in the health insurance or Medicaid program
Ability to distill complex data into meaningful insights and present findings to non-technical audiences
2+ years experience interpreting medical claim data
Advanced experience in SQL & Python coding sourcing from a data warehouse
3+ years of project leadership experience
Strong business as well as systems knowledge
Excellent problem-solving, critical thinking, and written communication skills
Advanced experience in Excel
Bachelor's degree preferred or a combination of work experience and education

Nice to have:

Experience in healthcare fraud, waste and abuse
Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting
Experience with data visualization tools (e.g., Tableau, Power BI)
Familiarity with Big Query & Jupyter Notebook

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 18, 2025

Expiration:
October 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Healthcare Analytics Business Consultant