Senior Analyst, Provider Compliance

CVS Health • Hartford, CT

2d

About The Position

CVS Health is seeking a Senior Analyst, Provider Compliance to lead Medicaid provider compliance, audit excellence, and regulatory integrity. The role ensures high-quality internal and external Medicaid provider audit results, supports regulatory compliance activities, and develops proactive risk-mitigation strategies. It applies expertise in compliance, business operations, analytics, and communication to meet regulatory and contractual obligations.

The position partners across the organization to deliver accurate, complete, and timely audit and regulatory materials; standardize processes; optimize workflows; and support data integrity. It leads provider compliance initiatives that promote consistency, accuracy, compliance, and operational excellence. The role calls for a strategic, solutions-oriented leader who can influence outcomes, manage complex initiatives, strengthen regulatory relationships, and improve audit performance and operational efficiency.

Requirements

• At least 3 years of progressive experience in audit, compliance, or related healthcare operations.
• Ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives.
• Strong analytical skills, including interpreting data, identifying trends, and recommending actionable compliance solutions.
• Advanced proficiency with Microsoft Excel for data analysis and reporting to strengthen internal controls and mitigate risk.
• Exceptional written and verbal communication skills, including explaining complex information clearly and concisely, building relationships across organizational levels, and influencing decisions.
• Ability to lead initiatives, mentor team members, and work in a fast-paced, evolving environment while maintaining compliance and quality standards.
• Bachelor's degree preferred, or specialized training or a relevant professional qualification.

Nice To Haves

• 5 years of progressive experience in audit, compliance, or related healthcare operations.
• Ability to interpret and apply business knowledge to implement state and federal laws and regulations affecting healthcare operations.
• At least 3 years of demonstrated success leading audits and complex projects, ensuring timely delivery, and driving measurable outcomes.
• At least 3 years of experience managing provider data operations, including compliance.
• At least 3 years of experience in network management, contracting, or related healthcare network functions.
• At least 1 year of hands-on experience with provider data management platforms.

Responsibilities

• Collaborate with internal teams and external auditors to deliver quality results, support continuous improvement, and maintain compliance.
• Interpret audit findings and recommend sustainable corrective actions and process improvements to mitigate risk.
• Support responses to complex inquiries from internal stakeholders and regulators, ensuring accuracy, timeliness, and completeness.
• Lead and manage multiple compliance-related projects and deliverables to ensure timely execution and desired outcomes.
• Oversee development of policy and procedural documentation and ensure required annual reviews are completed on time.
• Build productive partnerships across organizational levels, exercise sound judgment, remove barriers, and influence ethical, compliant outcomes.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior