Lead Decision Scientist: Affordability & Fraud Analytics

CVS Health Corporation; New York (NY); On-site; USD 93,000 - 222,000; Full time

Job summary

CVS Health is seeking a Lead, Senior Decision Scientist to drive analytics for Payment Integrity, focusing on Fraud, Waste & Error and Special Investigations Unit programs. You will lead a team of decision scientists, guiding ideation, development and implementation of data-driven opportunities that improve affordability and strengthen capabilities.

You will partner with SIU, Analytics & Behavior Change, Clinical Policy and Medical Economics to establish measurement frameworks, evaluate

Qualifications

• 7+ years in healthcare analytics or related fields.
• 5+ years leading analytical projects.
• Experience with healthcare claims platforms (ACAS, QNXT, HRP).
• Experience in SAS, SQL, Python, or R.
• Strong understanding of reimbursement methodologies.
• Ability to communicate complex findings to diverse audiences.

Responsibilities

• Provide day-to-day leadership, coaching, and mentorship to Decision Scientists while fostering a culture of innovation, collaboration, and accountability.
• Partner with SIU, Analytics & Behavior Change, Clinical Policy, Medical Economics, and Payment Integrity leaders to identify affordability and program improvement opportunities.
• Lead the intake, evaluation, prioritization, and governance of affordability and ideation opportunities.
• Identify emerging risks, trends, and operational challenges and recommend data-driven solutions.
• Develop long-term measurement frameworks and success metrics to evaluate ideation outcomes and business value realization.
• Identify synergies and scalability opportunities across Payment Integrity programs and initiatives.
• Present analyses and recommendations to leaders and stakeholders across multiple organizational levels.
• Lead ideation sessions and facilitate opportunity-generation activities across stakeholder groups.
• Develop business cases and value assessments supporting affordability opportunities.
• Maintain ideation governance processes including intake, prioritization, tracking, and outcome measurement.
• Develop executive-ready presentations and recommendations for senior leadership.
• Communicate analytical findings, risks, opportunities, and implementation considerations to decision-makers.
• Evaluate emerging analytical methodologies, automation opportunities, and AI-enabled solutions that support Payment Integrity objectives.
• Identify opportunities to enhance analytical efficiency through advanced tools, automation, and predictive modeling.

Skills

Healthcare analytics

Team leadership

SAS/SQL/Python/R

Data analysis

Communication

Problem solving

Stakeholder influence

Education

Bachelor's degree

Tools

ACAS

QNXT

HRP

SAS

SQL

Python

R

Job description

CVS Health is seeking a Lead, Senior Decision Scientist to drive analytics for Payment Integrity, focusing on Fraud, Waste & Error and Special Investigations Unit programs. You will lead a team of decision scientists, guiding ideation, development and implementation of data-driven opportunities that improve affordability and strengthen capabilities.

You will partner with SIU, Analytics & Behavior Change, Clinical Policy and Medical Economics to establish measurement frameworks, evaluate