Lead Decision Scientist - Affordability & Fraud Innovation

4062 Aetna Resources, LLC

Connecticut

On-site

USD 93,000 - 222,000

Full time

4 days ago

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Job summary

CVS Health is seeking a Lead Senior Decision Scientist to guide analytics for Payment Integrity, focusing on Fraud, Waste & Error and SIU programs. You will lead a team of decision scientists, shape ideation pipelines, and drive data-driven opportunities that improve affordability and enhance enterprise value.

The role requires extensive healthcare analytics experience, leadership, and strong communication with both technical and non-technical colleagues.

Qualifications

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

Responsibilities

Provide day-to-day leadership, coaching, and mentorship to Decision Scientists. Oversee onboarding, training, and performance expectations.
Partner with SIU, Analytics & Behavior Change, Clinical Policy, Medical Economics, and Payment Integrity to identify opportunities. Lead intake, evaluation, and governance of ideas.
Analyze complex healthcare, claims, provider, and investigative data to identify patterns and trends. Prepare integrated analytic datasets and reports.
Lead ideation sessions, develop business cases, and maintain governance for opportunities and outcomes.
Develop executive-ready presentations and communicate findings to leaders across the organization.
Evaluate AI-enabled opportunities and enhance analytical efficiency with advanced tools and predictive modeling.