Lead Director, Medicare Advantage & ACA Risk Analytics

Hispanic Alliance for Career Enhancement; Illinois; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Lead Director, Informatics in Revenue Integrity Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. This senior role ensures risk score accuracy, regulatory compliance, and data-informed opportunities.

This position may sit anywhere in the US and collaborates with finance, actuarial, and clinical teams to translate insights into strategic recommendations.

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 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 analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Direct prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.
• Lead development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Drive automation and innovation to improve efficiency and scalability.
• Measure and evaluate intervention effectiveness and overall business impact.
• Translate complex analytical findings into practical recommendations to improve operational, clinical, and financial outcomes.
• Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.

Skills

Healthcare analytics

Informatics

Risk adjustment

Leadership

Data science

SQL

SAS

Python

BigQuery

Machine learning

Education

Bachelor's degree or equivalent

Master's degree preferred

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director, Informatics in Revenue Integrity Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. This senior role ensures risk score accuracy, regulatory compliance, and data-informed opportunities.

This position may sit anywhere in the US and collaborates with finance, actuarial, and clinical teams to translate insights into strategic recommendations.