Manager MPPS Policy Business Analytics

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary The Manager, Medical Policy Business Analytics is responsible for managing analytics, reporting, performance measurement, and operational intelligence activities that support Medical Policy and Payment Integrity functions. This role translates healthcare, claims, policy, utilization, and operational data into actionable insights that help inform business decisions, monitor performance, improve operational quality, support affordability initiatives, and strengthen compliance readiness. The position partners with Clinical Operations, Medical Policy, Payment Integrity, Technology, Finance, Compliance, Quality, and Enterprise Reporting teams to identify opportunities for improvement, support policy governance activities, monitor key performance indicators, and deliver practical data-driven recommendations. The Manager supports day-to-day analytical work, dashboard development, data validation, root cause analysis, performance monitoring, and business intelligence activities while ensuring deliverables are accurate, timely, and aligned with business priorities. Key Accountabilities Medical Policy Performance Analytics (25%) Manage the development and maintenance of performance reporting for Medical Policy, Payment Integrity, and related operational programs. Develop, maintain, and monitor scorecards, key performance indicators (KPIs), and trend analyses. Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness. Identify opportunities to improve affordability, quality, and operational efficiency through data-driven insights. Prepare clear summaries, dashboards, and presentation materials for leadership review. Business Intelligence & Reporting Solutions (20%) Oversee the design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions. Provide subject matter input on reporting and business intelligence tools and support consistent use of reporting standards. Partner with data management and technology teams to improve data accessibility and reporting capabilities. Support delivery of accurate, timely, and actionable reporting for business partners and leadership stakeholders. Promote self-service analytics and reporting capabilities where appropriate. Policy Governance, Compliance & Quality Monitoring (15%) Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements. Support policy governance committees through reporting, trend analysis, and metric development. Partner with Quality Assurance and Compliance teams to identify and mitigate operational risks. Support internal audits, regulatory reviews, corrective action plans, and remediation efforts. Business Process Improvement & Operational Excellence (15%) Conduct root cause analyses to identify drivers of defects, policy exceptions, rework, and operational inefficiencies. Support continuous improvement initiatives targeting quality enhancement, defect reduction, and process optimization. Develop performance improvement recommendations supported by quantitative analysis. Measure and monitor outcomes associated with process improvement initiatives. Business Requirements & Strategic Initiatives (10%) Partner with business stakeholders to gather and document reporting, analytics, and operational requirements. Support BRD development and translation of business needs into technical solutions. Support strategic initiatives, system implementations, and