Lead Director: Payment Integrity Analytics & Optimization

CVS Health Corporation; Northern (KY); Hybrid; USD 100,000 - 232,000; Full time

Job summary

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

You will establish KPIs, monitor deployment impact, and deliver executive reporting to leadership, while partnering with Finance to ensure transparent savings methodologies and optimized outcomes.

Qualifications

• 5+ years of healthcare/payments analytics and leadership.
• Experience leading analytics-driven performance management.
• Ability to translate data into business decisions.
• Experience developing executive dashboards and performance reporting.
• Bachelor’s degree required.

Responsibilities

• Establish a standardized performance measurement framework across Payment Integrity editing platforms.
• Monitor edit performance following deployment and throughout the edit lifecycle.
• Develop KPIs and performance scorecards for the editing portfolio.
• Analyze trends in claims, savings, utilization, provider behavior, and edit outcomes.
• Establish thresholds for optimization or remediation and provide executive reporting.
• Own independent measurement and validation of edit savings.
• Monitor expected versus realized savings after deployment.
• Identify variance between projected and actual financial performance.
• Partner with Finance to establish consistent savings methodologies.
• Ensure savings reporting is accurate and transparent.
• Establish QA framework for deployed edits across GCP, Lyric, Cotiviti.

Skills

Leadership

Analytics

Data analysis

Performance management

Executive dashboards

Healthcare payments

Education

Bachelor’s degree

Tools

Power BI

Job description

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

You will establish KPIs, monitor deployment impact, and deliver executive reporting to leadership, while partnering with Finance to ensure transparent savings methodologies and optimized outcomes.