Manager, SIU Data Analysis, CVS Health

CVS Health

Location:
United States, Remote

Category:
IT - Software Development

Contract Type:
Employment contract

Salary:

54300.00 - 145860.00 USD / Year

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Job Description:

We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This role is ideal for a data professional with strong skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting.

Job Responsibility:

Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets
Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity
Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and standards
Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences
Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements
Develop and participate in presentation and consultation with business partners on data, capabilities and performance results
Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity
Document data logic and methodology used in analyses and ensure reproducibility and transparency of results
Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.

Requirements:

3+ years of experience in data analytics or data science, preferably in healthcare, health insurance, or Medicaid programs
Ability to distill complex data into meaningful insights and present findings to non-technical audiences
Solid understanding and experience interpreting medical claim data
Advanced experience in SQL coding sourcing from a data warehouse
3+ years of data interpretation and analysis experience
3+ years of project leadership experience
Strong business as well as systems knowledge
Excellent problem-solving, critical thinking, and written communication skills
Advanced experience in Excel.

Nice to have:

Experience in healthcare fraud, waste and abuse
Proficiency in Python coding
Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting
Experience with data visualization tools (e.g., Tableau, Power BI)
Familiarity with Big Query & Jupyter Notebook.

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation, and weight management programs
Confidential counseling and financial coaching
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Paid time off
Flexible work schedules.

Additional Information:

Job Posted:
May 24, 2025

Expiration:
June 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Manager, SIU Data Analysis