Lead Director- Informatics Reporting

• Overturn reduction drivers

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…