[Remote] Healthcare Analytics Business Consultant (SQL / Python) at CVS Health

Connecticut, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

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
Bachelor’s degree preferred or a combination of work experience and education

Responsibilities

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

Skills

Key technologies and capabilities for this role

SQLPythonData AnalysisHealthcare DataData VisualizationETLMedicaid ClaimsFraud Detection

Questions & Answers

Common questions about this position

What is the work location or remote policy for this role?

This position can sit anywhere in the United States, but must work East Coast hours. It is a full-time individual contributor role.

What are the required skills and experience for this position?

Candidates need a minimum of 3 years of data interpretation and analysis experience (preferably in health insurance or Medicaid), 2+ years interpreting medical claim data, advanced experience in SQL and Python coding from a data warehouse, and 3+ years of project leadership experience. Strong business and systems knowledge, problem-solving, critical thinking, and written communication skills are also required.

What is the salary or compensation for this role?

This information is not specified in the job description.

What is the company culture like at CVS Health?

CVS Health emphasizes building a world of health around every consumer with dedicated, purpose-driven colleagues passionate about transforming health care in a more connected, convenient, and compassionate way.

What makes a strong candidate for this Healthcare Analytics Business Consultant role?

A strong candidate will have 3+ years of data analysis experience in health insurance or Medicaid, advanced SQL and Python skills for healthcare data, experience with medical claims, and the ability to communicate insights to non-technical audiences. Preferred qualifications include knowledge of healthcare fraud, waste, and abuse as well as Medicaid claims adjudication.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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