HEDIS Performance Analytics Lead

🕒 5 days ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $83.8k - $157.9k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

Healthcare Insurance • Finance • B2C

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Lead the development of predictive models to identify members at risk of care gaps and prioritize outreach opportunities • Perform advanced statistical analyses to uncover drivers of HEDIS performance variation • Develop segmentation strategies (provider, population, geography) to target high-impact interventions • Design forecasting models to project HEDIS performance and simulate intervention scenarios • Translate complex analytical findings into clear, actionable recommendations for executive and operational stakeholders • Identify the highest-value opportunities for improvement based on impact, feasibility, and ROI • Establish frameworks to measure the effectiveness of HEDIS interventions and initiatives • Conduct pre/post and longitudinal analyses to evaluate program impact • Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost of care implications • Design and oversee enterprise HEDIS performance dashboards and reporting tools • Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs

🎯 Requirements

• 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement • Advanced analytical skills, including experience with predictive modeling, statistical analysis, and large datasets • Demonstrated ability to translate data into actionable insights that drive measurable outcomes • Proficiency in data tools and programming languages (e.g., SQL, Python, R) • Experience with data visualization tools (e.g., Tableau, Power BI)

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement