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Job Description Summary
In this role, you will support the strategy, oversight, and valuation of vendors serving Medicare and Medicaid risk adjustment programs. The position evaluates vendor capabilities and performance, develops financial and return-on-investment analyses, and uses data to forecast revenue impact and identify risks and opportunities. It partners with business, technical, and regional stakeholders to translate risk adjustment requirements into effective vendor solutions, governance routines, and performance measures. The role also presents valuation findings, recommendations, and escalation items to senior leaders while promoting compliant, accountable, and analytically driven decision-making.
What you will do
- Support vendor management teams and regional stakeholders with vendor strategy, selection, contracting, onboarding, performance management, and issue resolution for Medicare and Medicaid risk adjustment programs
- Develop and maintain vendor valuation methodologies that quantify financial opportunity, return on investment, operational impact, and performance against contractual commitments
- Evaluate vendor capabilities, data quality, coding accuracy, submission readiness, scalability, and alignment with enterprise risk adjustment objectives
- Establish scorecards, key performance indicators, and governance routines to monitor vendor performance
- Use technology and programing skillsets to oversee data, reporting, and analytics needed to assess risk adjustment performance, forecast revenue impact, reconcile results, and identify emerging opportunities or risks
- Translate Medicare and Medicaid risk adjustment requirements into clear business, data, and technology specifications for internal teams and external vendors
- Develop, maintain, and execute analytics and AI-enabled capabilities that improve vendor oversight, valuation accuracy, operational efficiency, and decision-making while maintaining accountability
- Design and maintain documentation for vendor processes, data flows, and valuation models
- Present vendor performance, valuation findings, recommendations, and escalation items to senior leaders and governance forums
Required Qualifications
- 3+ years of relevant experience in healthcare analytics, risk adjustment, vendor management, financial analysis, or an equivalent combination of experience
- Working knowledge of Medicare Advantage, Medicare Part D, Medicaid, and state-specific risk adjustment programs
- 2+ years of experience with SQL and/or Python for data analysis, validation, reconciliation, and performance measurement
- 2+ years of experience with business intelligence reporting tools such as Amazon Quick, Tableau, or Power BI
- Strong problem-solving, decision-making, planning, execution, collaboration, and stakeholder management skills
Preferred Qualifications
- Experience with Medicare Advantage, Part D, Medicaid, or state risk adjustment models, data submissions, reconciliation, and revenue forecasting
- Experience evaluating and managing risk adjustment vendor performance
- Experience developing vendor valuations, financial forecasts, sensitivity analyses, and return-on-investment assessments
- Experience with contract performance measures, procurement processes, vendor scorecards, and executive governance
- Experience using governed analytics or AI-enabled capabilities to improve risk adjustment operations, valuation, or vendor oversight
- Experience with cloud platforms such as Amazon Web Services (AWS) and Google Cloud Platform (GCP)
- Experience working with Databricks to query data, develop analysis, and deploy dashboards
Education
- Bachelor's degree preferred/specialized training/relevant professional qualification.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,300.00 - $145,860.00
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.
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: 11/14/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
