HEDIS Data Analyst / Business Analyst

Role overview

We are looking for a HEDIS-focused Data Analyst / Business Analyst with 4–6+ years of experience in the healthcare payer space. The position calls for deep familiarity with HEDIS reporting, CMS quality programs, healthcare claims data, and payer operations.

The right candidate should have practical experience in a health plan or other payer environment and be able to turn healthcare data into clear, actionable insights that support HEDIS, CMS STARs, quality improvement, and regulatory reporting work. This role connects business teams, quality specialists, operational leaders, and technical teams to help ensure reporting is accurate, compliant, and performance-driven.

Key responsibilities

You will support HEDIS measurement, reporting, validation, and annual submission activities. The role also includes interpreting HEDIS specifications and converting business needs into reporting and data solutions.

You will review HEDIS results to find ways to improve quality scores and reduce care gaps, while working closely with quality, population health, provider engagement, and care management teams.

Other duties include helping with HEDIS audits, documentation checks, and quality assurance work; collecting, analyzing, documenting, and validating business requirements; and performing root-cause analysis on data issues that affect HEDIS, CMS reporting, and operational results.

You will create source-to-target mappings, business rules, process flows, and functional specifications, as well as analyze large healthcare datasets and present trends, findings, and recommendations to stakeholders.

The position also involves supporting UAT, reconciliation, defect fixes, and deployment validation. You will analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used in HEDIS and CMS reporting, verify completeness and accuracy, and help improve reporting workflows and data governance practices.

In addition, you will support CMS quality initiatives, STAR Ratings programs, and regulatory reporting, understand payer operational processes such as claims, provider data, membership, enrollment, and quality management, and work with consultants and client stakeholders to resolve complex data challenges. You will also facilitate requirements sessions, stakeholder interviews, and process reviews, translate technical outputs into business recommendations, and support payer transformation and data modernization efforts.

Requirements

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or a related discipline; comparable experience may be accepted in place of a degree.
• At least 4–6+ years of experience in healthcare payer, health plan, or managed care settings.
• Strong practical knowledge of HEDIS and experience supporting HEDIS reporting initiatives.
• Background working with a health plan, managed care organization, Medicare Advantage, Medicaid, or commercial payer environment.
• Understanding of CMS regulations, STAR Ratings, quality programs, and regulatory reporting obligations.
• Experience working with healthcare data such as claims, encounters, membership/eligibility, provider data, pharmacy data, and supplemental clinical data.
• Solid business analysis capabilities, including requirements gathering, process documentation, and stakeholder coordination.
• Advanced SQL skills for healthcare data analysis and validation.
• Experience with data quality reviews, reconciliations, and root-cause analysis.
• Strong communication and presentation skills.

Additional information

This is an onsite contract role based in the United States.

The posting does not specify salary, stipend, duration, start date, application deadline, perks, or number of openings.