Healthcare Analytics Business Consultant (SQL / Python)

CVS Health-posted 9 days ago

Full-time • Mid Level

Remote • Tennessee, IL

5,001-10,000 employees

Ambulatory Health Care Services

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At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.This is an individual contributorThis position can sit anywhere in the United States, but must work East Coast hoursPosition SummaryWe are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This is a full time role and is ideal for a data professional with strong coding 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. This is an individual contributor role.

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.
Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.

A minimum of 3 years of data interpretation and analysis experience, preferable in the health insurance or Medicaid program.
Ability to distill complex data into meaningful insights and present findings to non-technical audiences.
2+ years experience interpreting medical claim data
Advanced experience in SQL & Python coding sourcing from a data warehouse
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

Experience in healthcare fraud, waste and abuse
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

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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Healthcare Analytics Business Consultant (SQL / Python)

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