Lead Director- Informatics Reporting

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.

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.

• 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.

• Leads teams of data analysts and specialists to analyze core G&A data and generate actionable insights
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• 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
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• Ensures adherence to healthcare regulations and audit requirements specific to grievances and appeals.
• Maintains high standards of data integrity, traceability, and auditability
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• Aligns reporting practices with enterprise data governance standards
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• 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
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• 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
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• 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
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• 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

• 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…