Healthcare Analytics Business Consultant (SQL / Python)

waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role.Job responsibilities include:

• 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.

This is a work-from-home position in the US. supporting standard east coast business hours.Required Qualifications

• 3+ years of experience in data analytics or data science in healthcare, health insurance, or Medicaid programs
• 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 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

Preferred Qualifications

• 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

Education

• Bachelor's degree or equivalent experience

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$54,300.00 - $145,860.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.