Lead Director, Risk Adjustment Performance Reporting and Insights

4062 Aetna Resources, LLC; Town of Texas (WI); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Wellness programs

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Lead Director, Informatics to drive enterprise risk adjustment analytics and BI capabilities. You will transform clinical, operational, and risk data into actionable insights, guiding provider performance, program efficiency, and executive decisions.

You will lead a small team, partner with Market leads, Finance, Clinical, and IT, and steer AI-driven analytics modernization across platforms and dashboards.

Qualifications

• 10+ years of healthcare analytics, informatics, performance insights, actuarial, value‑based, or BI experience.
• 2+ years of leadership experience managing analytics, reporting, or BI.
• Strong executive communication, strategic thinking, stakeholder management, and team development skills.
• Advanced experience with programming languages (SQL, Python) and BI platforms such as Power BI, Tableau, QuickSight.

Responsibilities

• Lead risk adjustment performance reporting and dashboards for market, plan, and provider levels.
• Quantify drivers of risk movement and surface insights to leaders for action.
• Oversee provider performance analytics and identify opportunities across markets and lines of business.
• Drive analytics modernization, AI adoption, and self‑service reporting capabilities.
• Partner with Informatics, Data Engineering, and IT to build scalable analytics solutions.

Skills

Healthcare analytics

Leadership

Executive communication

SQL

Python

Power BI

Tableau

QuickSight

Portfolio leadership

Education

Bachelor’s degree or equivalent

Master’s degree preferred

Tools

Power BI

Tableau

QuickSight

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Revenue Integrity is seeking a Lead Director, Informatics (Performance Reporting & Insights) to lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions. This role transforms complex clinical, operational, and risk adjustment data into actionable insights that will drive provider performance, program efficiency, and executive decision‑making. This leader will be responsible for creating action through data storytelling, advanced visualizations, and helping to advance the organization’s reporting strategy through AI and automation. This role is customer‑facing and will provide thought leadership and vision partnership to areas such as Market leads, Finance, Clinical, and Operational partners. The leader must also provide technical guidance to staff on BI tool input modeling and calculations.

Risk Adjustment Performance Reporting

• Accountable for timely and accurate sharing of risk adjustment KPIs, trends, and performance drivers at a market, plan, and provider level through dashboards and reporting tools
• Quantify drivers of risk movement and surface those insights to business leaders for action
• Assess performance against operational and organizational objectives, including appropriate benchmarking and goal setting
• Deliver executive insights and recommendations that support market strategy, operational planning, and performance improvement initiatives.
• Leverage underlying healthcare data, including claims, encounter, and clinical information, for deeper level learnings on drivers of outcomes

Provider Performance Analytics

• Develop and oversee provider performance analytics that deliver actionable insights into gap closure, engagement, and overall risk adjustment outcomes.
• Monitor provider performance across key metrics and identify variation, emerging trends, opportunities, and best practices across markets, specialties, and lines of business.
• Partner with provider, clinical, and operational leaders to support performance improvement initiatives through data-driven insights and targeted intervention strategies.
• Evaluate the effectiveness of provider-facing risk adjustment programs, value‑based care, point‑of‑care enablement solutions, and other clinical and operational initiatives.

Analytics Innovation & Business Intelligence

• Lead in the adoption of AI, advanced analytics, automation, and modern business intelligence capabilities.
• Drive modernization of analytics platforms, data solutions, and self‑service reporting tools.
• Leverage predictive analytics and data visualization to improve insight generation and forecasting.
• Partner with Informatics, Data Engineering, and IT teams to build scalable, integrated analytics solutions.
• Establish KPI definitions, governance standards, and a trusted enterprise analytics framework.
• Establish and oversee analytics delivery priorities, ensuring effective intake management, work prioritization, resource allocation, and coordination across reporting and stakeholder needs.

Team Leadership & Stakeholder Engagement

• Lead, mentor, and develop a high‑performing analytics and business intelligence team (approx. 4-5 direct reports and overall scope 7-8 employees)
• Partner with executive leaders across Risk Adjustment, Finance, Actuarial, Clinical, Provider, and IT organizations.
• Foster a culture of accountability, innovation, collaboration, and continuous learning
• Champion and encourage new ideas, thinking, and ways to incorporate AI and advanced technology into everyday work.

Required Qualifications

• 10+ years of healthcare analytics, informatics, performance insights, actuarial, value‑based, or business intelligence experience.
• 2+ years of leadership experience managing analytics, reporting, or business intelligence
• Strong executive communication, strategic thinking, stakeholder management, and team development skills.
• Advanced experience and familiarity with programming languages (such as SQL, Python, etc.) and BI platforms such as Power BI, Tableau, QuickSight
• Proven ability to lead complex analytics portfolios, establish priorities, and maintain organization in developer code and processes

Preferred Qualifications

• Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements.
• Experience at a health plan or provider system
• Education Bachelor’s degree or equivalent professional work experience
• Master’s degree in Business, Informatics, Analytics, Finance, Statistics, Computer Science, Public Health, Healthcare analytics, Actuarial, Mathematics, Economics, or equivalent combination of advanced education, professional certification, or demonstrated subject matter expertise preferred

Pay Range

The typical pay range for this role is: $100,000.00 - $231,540.00. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/09/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self‑disciplined, hard‑working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.