Director, Performance Analytics & Optimization

CVS Health

Indianapolis (IN)

On-site

USD 100,000 - 232,000

Full time

5 days ago

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Benefits offered by this job

Medical, dental, vision

Bonus program

Equity awards

Job summary

CVS Health is seeking a Lead Director to provide objective oversight of edit performance, savings realization, and quality across the Payment Integrity editing portfolio, including GCP, Lyric, Cotiviti and related solutions. You will drive KPI development, dashboards, and executive reporting while partnering with Finance and leadership on savings methodologies.

This is a full-time role based in Indianapolis, with cross-functional collaboration across business units to optimize savings and

Qualifications

5+ years in healthcare, Payment Integrity, analytics, data, or related field.
5+ years of leadership experience managing teams or complex enterprise programs.
Experience leading analytics-driven performance management.
Experience with large datasets and translating data into business decisions.
Experience developing executive dashboards and performance reporting.

Responsibilities

Establish and maintain a standardized performance measurement framework across Payment Integrity editing platforms.
Monitor edit performance following deployment and throughout the edit lifecycle.
Develop and maintain KPIs and performance scorecards for the editing portfolio.
Analyze trends in claims, savings, utilization, provider behavior, and edit outcomes.
Identify underperforming, overperforming, or anomalous edits requiring investigation.
Establish performance thresholds and triggers for optimization or remediation.
Provide executive-level reporting and insights to Payment Integrity leadership.
Own the independent measurement and validation of edit savings.
Identify variance between projected and actual financial performance; collaborate with Finance and leadership.
Ensure savings reporting is accurate, transparent, repeatable, and supported by data.
Identify opportunities to improve savings realization through optimization.
Establish an independent quality assurance framework for deployed edits.
Monitor edit accuracy and effectiveness across platforms.
Evaluate whether edits are producing the intended outcome after deployment.
Identify quality defects, unintended outcomes, and opportunities for remediation.
Establish quality standards, sampling methodologies, and ongoing monitoring practices.
Provide objective feedback to editing and solution design teams.
Establish enterprise standards for measuring edit precision, recall, and false-positive rates.
Monitor edits for inappropriate or unnecessary claim impacts and optimize accordingly.
Partner with editing teams to determine appropriate optimization strategies.
Balance financial opportunity with edit accuracy, provider experience, and operational efficiency.
Establish a structured continuous optimization process for the editing portfolio.
Identify opportunities to modify, refine, expand, reduce, or retire edits based on performance data.
Develop optimization recommendations based on empirical performance rather than anecdotal feedback.
Establish post-deployment review cycles and performance thresholds; prioritize optimization by impact.
Track optimization recommendations through to completion and measure impact.
Establish a centralized performance reporting strategy for Payment Integrity editing.
Oversee development and maintenance of Power BI dashboards and executive reporting.