SIU Healthcare Analytics Business Consultant (SQL/Python)

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.

Position Summary
We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This role is ideal for a data professional with strong skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and operational, customer-facing, & 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 healthcare claims and provider activity.
• Prepare timely and accurate operational and customer-facing 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 cross-functional teams (SIU Investigators & Leadership, Program Integrity Managers & 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 policy, workflows, and FWA detection techniques to ensure ongoing compliance.
• This is a hybrid/remote position in the US. supporting standard east coast business hours.

Required Qualifications

• 3+ years of experience in data analytics or data science, preferably in healthcare, health insurance, or Medicaid/Medicare programs
• Ability to distill complex data into meaningful insights and present findings to non-technical audiences.
• Solid understanding and 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 for data analysis (Pandas, NumPy)
• Knowledge of healthcare claims, adjudication & reporting
• Experience with data visualization tools (e.g., Tableau, Power Bl)
• Familiarity with Big Query & Jupyter Notebook

Education

• Bachelor's degree or equivalent experience

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

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.

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

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