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CVS Health Informatics Consultant Lead in WORK FROM HOME, Texas

Job Description

The Informatics Consultant designs and executes claim operational analysis, creating insight into the Medical and Dental claim operational environments for Aetna actuaries, Service Operations Leadership, Compliance, Market leads and production teams. The Consultant evaluates the operational and financial flow of claims throughout the claim lifecycle, across multiple claim systems, and includes both a) monitoring normal flow and b) identifying and quantifying topics of concern. The position also builds information resources to support tactical operational needs, fulfills requests for operational data, and performs a variety of analysis to support Service Operations' needs. As a member of our Claim Operations Analytics team, you'll have the opportunity to learn as you provide valuable information to decision-makers.

Required Qualifications

  • 3+ years experience using SAS, SQL or similar query language, to extract, transform, process and summarize large datasets- 2+ years performing large scale analysis on medical claim operational (i.e., non-clinical) data. Examples such as auto-adjudication rates, turnaround times, payment patterns, inventory composition, denial rates, etc.- Demonstrated business knowledge of the medical claim lifecycle (Claim Intake, Adjudication, Editing, Pend/Inventory management, Payment, Appeals, Rework)- Demonstrated ability to manage multiple projects simultaneously- Experience performing data 'quality and reasonableness' testing on claim operational data - Strong Excel skills, including mastery of logical & text functions, pivot tables- Experience applying logic and critical thinking to solve business problems involving operational data- Experience turning data into information- Excellent written communication skills

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • Experience using Python, SQL or similar programming to perform complex data-processing operations beyond simple 'extract & transform' queries- Excellent professional presentation skills- Experience creating Tableau dashboards


Bachelor's degree or equivalent experience

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.