Job Description

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.

A Brief Overview

The Lead Director – Informatics is responsible for defining and executing the data and reporting strategy for the Grievances & Appeals (G&A) organization, enabling timely, accurate, and actionable insights to improve operational efficiency, compliance, and decision-making. This role builds internal analytics capabilities, strengthens reporting processes, and develops a high-performing team.

What You Will Do:

Reporting Strategy & Execution

• Manages and optimizes Informatics reporting processes, systems, and strategies to provide accurate and timely information to key stakeholders.

• Provides strategic leadership in the development and execution of reporting strategies aligned with the organization's goals.

• Oversees the selection, implementation, and maintenance of reporting systems, schedules, and infrastructure.

• Evaluates and recommends appropriate reporting tools, databases, and platforms to support efficient and accurate reporting processes.

• Collaborates with stakeholders to identify reporting needs and requirements, design and create meaningful visualizations, and ensure data accuracy and consistency.

• Establishes and enforces reporting governance frameworks, policies, and procedures by ensuring compliance with relevant regulations, such as data privacy, security, and industry standards.

• Identifies opportunities to enhance reporting efficiency, accuracy, and usability through automation, data visualization, and self-service reporting capabilities.

• Establishes performance metrics and reporting mechanisms to assess the effectiveness of reporting initiatives.

• Act as a bridge between IT delivery, enterprise analytics, and clinical/Operational leadership to ensure risk management and regulatory compliance needs.

Advanced Analytics & Insights

• Leads teams of data analysts and specialists to analyze core G&A data and generate actionable insights

• Enables visibility into:

  • Appeals turnaround time

  • Overturn reduction drivers

  • Grievance trends

  • Root cause analysis

  • Regulatory performance metrics

  • Productivity Metrics

• Drives proactive insights for operational improvement and compliance readiness

Governance, Compliance & Quality

• Ensures adherence to healthcare regulations and audit requirements specific to grievances and appeals.

• Maintains high standards of data integrity, traceability, and auditability

• Aligns reporting practices with enterprise data governance standards

Internal Capability Development

• Builds in-house informatics and analytics capabilities to reduce reliance on external teams.

• Establishes scalable operating models, reusable data assets, and self-service solutions.

• Drives continuous improvement through automation and standardization

Team Leadership & Development

• Creates robust job functions and role clarity within the informatics team.

• Leads, mentors, and develops talent across analytics, reporting, and domain expertise.

• Promotes a growth mindset, agility, and continuous learning culture

Healthcare Domain Focus (Critical)

• Applies deep expertise in:

  • Healthcare claims, grievances, authorization and appeals processes

  • Appeals lifecycle management and compliance tracking

• Ensures data and reporting enable regulatory compliance, audit readiness, and operational excellence

Required Qualifications:

• 10+ years of experience in informatics, analytics, or business intelligence

• Strong healthcare domain experience, preferably in: Claims, grievances, authorization and appeals

• Demonstrated leadership in data strategy, reporting, and team development

Preferred Qualifications:

• Experience in Aetna EDP platform.

• Experience in GCP (Big Query, Looker, Cloud)

• Experience in implementing AI technologies into existing reporting processes.

• Experience Coginiti, Dataiku, Tableau, PBI, SAP reporting tools, Quick Base.

• Familiarity with Agile SDLC.

• Proficient in Office tools (Power point/Excel/word) and Share point.

• Experience engaging with executive leadership.

• Experience in identifying and implementing process improvements.

• Experience leading analytics team and translating their requirements into clear, actionable solutions.

Education:

Bachelors Degree Required, Masters Preferred

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This 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. This position also includes an award target in the company’s equity award program.

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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments

We anticipate the application window for this opening will close on: 07/27/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.