Head of Payment Integrity Analytics & Optimization

CVSHealth; Massachusetts; On-site; USD 100,000 - 232,000; Full time

Job summary

CVS Health is seeking a Lead Director to oversee edit performance, savings realization, accuracy, and QA across the Payment Integrity editing portfolio, including GCP, Lyric, Cotiviti, and related solutions.

The role establishes standardized frameworks, builds KPIs, and delivers executive insights to leadership, driving optimization and value realization across complex datasets and edits.

Qualifications

• 5+ years of healthcare/analytics experience.
• 5+ years of leadership managing teams or programs.
• Experience translating data into business decisions and dashboards.

Responsibilities

• Establish standardized performance framework across Payment Integrity editing platforms.
• Monitor edit performance post-deployment and across lifecycle.
• Develop KPIs and scorecards for the editing portfolio.
• Provide executive-level reporting and insights to leadership.
• Own measurement of edit savings and monitor realized savings.

Skills

Healthcare experience

Leadership experience

Analytics

Data analysis

Executive dashboards

Education

Bachelor’s degree

Tools

Power BI

Job description

CVS Health is seeking a Lead Director to oversee edit performance, savings realization, accuracy, and QA across the Payment Integrity editing portfolio, including GCP, Lyric, Cotiviti, and related solutions.

The role establishes standardized frameworks, builds KPIs, and delivers executive insights to leadership, driving optimization and value realization across complex datasets and edits.