Senior Director, Medicare Advantage Risk Analytics & AI

Hispanic Alliance for Career Enhancement; Virginia (MN); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

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

This role may sit anywhere in the US and requires strong leadership, advanced analytics, and collaboration with finance, actuarial, and clinical teams to translate insights into strategic action.

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 technical 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 the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.
• Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Drive innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability.
• Measure and evaluate intervention effectiveness and overall business impact.
• Translate complex analytical findings into practical recommendations that improve operational, clinical, and financial outcomes.
• Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.
• Provide executive-level presentations and recommendations that influence organizational strategy and investment decisions.

Skills

Healthcare analytics

Leadership

SQL

SAS

Python

BigQuery

Predictive analytics

Machine learning

Data science concepts

Education

Bachelor's degree

Master's degree preferred

Job description

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

This role may sit anywhere in the US and requires strong leadership, advanced analytics, and collaboration with finance, actuarial, and clinical teams to translate insights into strategic action.