HEDIS Performance Analytics Lead

🔥 16 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $86.7k - $161k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

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This company has sponsored H1B visas in the past.

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

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 predictive modeling to identify members at risk of care gaps and prioritize outreach • Perform statistical analyses to identify drivers of HEDIS performance variation • Develop provider, population, and geographic segmentation strategies • Design forecasting models and simulate intervention scenarios • Translate analytical findings into recommendations for executive and operational stakeholders • Identify high-value improvement opportunities based on impact, feasibility, and ROI • Advise on HEDIS performance trends, risks, and opportunities • Establish frameworks to measure HEDIS intervention effectiveness • Conduct pre/post and longitudinal program-impact analyses • Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost-of-care implications • Design and oversee enterprise HEDIS dashboards and reporting tools • Partner with the Analytics and Reporting HEDIS Technical team on data quality, integration, and accessibility • Automate reporting and insight generation for real-time performance monitoring • Collaborate with Clinical, Quality, Provider Engagement, and Operations teams • Enable stakeholders with data, tools, and insights for targeted improvement initiatives • Present findings and recommendations to senior leadership • Maintain expertise in HEDIS specifications, including hybrid and administrative measures • Identify opportunities to improve measure capture, coding accuracy, and documentation • Support audit readiness through data validation and performance reconciliation

🎯 Requirements

• 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement • Advanced analytical skills, including predictive modeling, statistical analysis, and large datasets • Ability to translate data into actionable insights that drive measurable outcomes • Proficiency in SQL, Python, or R • Experience with Tableau or Power BI • Experience with NCQA HEDIS measures and reporting processes preferred • Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models preferred • Experience working with claims, EHR, and supplemental data sources preferred • Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field preferred

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible environment • Training and continuing education • Professional and personal growth opportunities • Community volunteering opportunities

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