HEDIS Data Analyst | Architect - Healthcare Payer
Core
Analyze and validate healthcare claims and member data to support HEDIS reporting, CMS quality programs, and regulatory compliance while contributing to solution architecture for data modernization.
Role type
Senior HEDIS Data Analyst | Architect (Healthcare Payer)
Builds
HEDIS measurement solutions, CMS reporting artifacts, and scalable data architecture for payer quality initiatives
Domain
Healthcare Payer / Health Insurance / Quality Reporting
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
HEDIS reporting expertise, CMS quality program knowledge, healthcare claims data analysis, solution architecture design, SQL, data quality validation, requirements gathering, stakeholder management
Preferred skills
Experience with Medicare Advantage/Medicaid/Commercial payers, data lineage concepts, integration design, root cause analysis
Technologies
SQL
Responsibilities
Support HEDIS measurement, reporting, validation, and annual submission activities; Interpret HEDIS measure specifications and translate business requirements into data solutions; Analyze HEDIS performance results to identify quality improvement opportunities; Contribute to HEDIS solution architecture including data flow design and reporting architecture; Partner with technical teams to align reporting requirements with platform capabilities; Perform root cause analysis on data quality issues; Develop source-to-target mappings and business rules; Analyze large healthcare datasets including claims, encounters, and pharmacy data; Support UAT testing and deployment validation.
Seniority
Mid-Senior, hands-on IC with architecture contributions