Director, Risk Adjustment Informatics & AI

CVS Health; Hartford (CT); On-site; USD 100,000 - 231,540; Full time

Benefits offered by this job

Medical, dental & vision coverage

Paid time off

Retirement savings options

Equity awards

Job summary

CVS Health is seeking a Lead Director, Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. The role leads a high-performing team and collaborates with senior leadership to inform strategic decisions.

Strong focus on risk score accuracy, regulatory compliance, and data-driven opportunities. The incumbent will partner with finance, compliance, and clinical teams to optimize processes, build opportunity algorithms, and advance

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.
• Leverage claims and clinical data for deep learning into drivers of performance and model impacts.
• Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities
• Oversee the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.
• Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts.

Skills

Healthcare analytics

Leadership

SQL

SAS

Python

BigQuery

Machine Learning

Financial modeling

Data science concepts

Influence leadership

Education

Bachelor’s degree

Master’s degree

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director, Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. The role leads a high-performing team and collaborates with senior leadership to inform strategic decisions.

Strong focus on risk score accuracy, regulatory compliance, and data-driven opportunities. The incumbent will partner with finance, compliance, and clinical teams to optimize processes, build opportunity algorithms, and advance