Director, Medicare Risk Adjustment Analytics & AI

CVS Health; Indiana (PA); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Lead Director, Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and data-informed opportunities with a senior leadership focus.

The role oversees a ~5 directs team and overall scope of 13, collaborating with executive leadership, finance, and vendor partners to create business impact. This is a US-based, full‑time leadership position.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, actuarial, finance, data science, or related disciplines.
• 2+ years of leadership experience (direct reports, team lead).
• Advanced technical proficiency in SQL, SAS, Python, BigQuery, or similar.
• Experience with predictive analytics, machine learning, financial modeling, or data science concepts.
• Demonstrated ability to influence leadership and deliver measurable business results.

Responsibilities

• Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms.
• Drive advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning.
• Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations.
• Lead, mentor, and develop a high-performing team across analytics, informatics, data science, and related disciplines.

Skills

Healthcare analytics

Leadership experience

Predictive analytics

Machine learning concepts

Data science concepts

Education

Bachelor's degree or equivalent

Master's degree in Business, Informatics, Analytics, Finance, Statistics, CS, Public Health, Healthcare analytics, Actuarial, Mathematics, Economics

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director, Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and data-informed opportunities with a senior leadership focus.

The role oversees a ~5 directs team and overall scope of 13, collaborating with executive leadership, finance, and vendor partners to create business impact. This is a US-based, full‑time leadership position.