Lead Director- Informatics Reporting

About the Role

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.
• Applies deep expertise in 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 with Coginiti, Dataiku, Tableau, PBI, SAP reporting tools, Quick Base.
• Familiarity with Agile SDLC.
• Proficient in Office tools (PowerPoint, Excel, Word) and SharePoint.
• 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

• Bachelor's Degree required.
• Master's Degree preferred.