Lead Decision Scientist: Affordability & Fraud Analytics

Socket.dev; Hartford (CT); On-site; USD 93,000 - 222,000; Full time

Job summary

CVS Healthis seeking a Lead Decision Scientist to guide analytics across Payment Integrity, focusing on affordability and SIU initiatives. You will lead a team of decision scientists, develop analytical frameworks, and partner with cross-functional teams to drive value.

The role requires deep healthcare analytics expertise, leadership, and the ability to translate complex insights into strategic actions for executives and stakeholders, in a fast-paced healthcare environment.

Qualifications

• 7+ years of healthcare analytics experience.
• 5+ years leading analytical projects or technical leadership.
• Experience with healthcare claims platforms such as ACAS, QNXT, HRP or similar.
• Experience using SAS, SQL, Python, or R.
• Understanding of healthcare reimbursement methodologies and Payment Integrity programs.
• Ability to communicate complex analytics to technical and non-technical audiences.

Responsibilities

• Provide day-to-day leadership, coaching, and mentorship to Decision Scientists.
• Assist leadership with recruitment, onboarding, training, and development of team members.
• Monitor workload prioritization and progression of ideation concepts to implementation.
• Establish and monitor performance expectations, milestones, and quality standards for deliverables.
• Partner with SIU, Analytics & Behavior Change, Clinical Policy, Medical Economics, and Payment Integrity leaders to identify opportunities.
• Lead intake, evaluation, prioritization, and governance of affordability opportunities.
• Identify risks, trends, and operational challenges and propose data-driven solutions.
• Develop long-term measurement frameworks and success metrics for ideation outcomes.
• Identify synergies across Payment Integrity programs and initiatives.
• Consult business partners to understand strategic goals and analytical requirements.
• Analyze healthcare data to identify patterns and opportunities.
• Prepare large-scale datasets, dashboards, and predictive analyses.
• Collaborate to refine methodologies and solution effectiveness.
• Present analyses to leaders and stakeholders.

Skills

Healthcare analytics

Leadership

Data analysis

Communication

Education

Bachelor's degree in Business Analytics, Data Science, Healthcare Administration, Statistics, Economics, Computer Science, or related field

Tools

SAS

SQL

Python

R

Job description

CVS Healthis seeking a Lead Decision Scientist to guide analytics across Payment Integrity, focusing on affordability and SIU initiatives. You will lead a team of decision scientists, develop analytical frameworks, and partner with cross-functional teams to drive value.

The role requires deep healthcare analytics expertise, leadership, and the ability to translate complex insights into strategic actions for executives and stakeholders, in a fast-paced healthcare environment.