[Remote] HEDIS & Stars Analyst

Note: The job is a remote job and is open to candidates in USA. WellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for its members. The HEDIS and Stars Analyst is responsible for driving performance improvement through data analysis and visualization, supporting quality initiatives, and ensuring compliance with regulatory requirements.

Responsibilities

• Extract, clean, and transform large datasets from claims, EMRs, and other data sources
• Create and manage complex Excel models, including pivot tables and advanced formulas
• Perform statistical and trend analyses to identify gaps in care and opportunities for improvement
• Formulate and implement validation strategies and methods to ensure accurate and reliable data
• Design and maintain interactive dashboards using tools such as Tableau, Power BI, or QuickSite
• Automate reporting processes to ensure timely and accurate delivery of performance metrics
• Collaborate with stakeholders to define KPIs and customize visualizations for various audiences
• Consult with subject matter experts to identify information needs and outline optimal reporting formats to achieve business objectives
• Translate data findings into clear, actionable insights for clinical, quality and operational teams
• Conduct root cause analysis on low-performing measures and recommend improvement strategies
• Present analytical results to leadership with recommendations for strategic interventions
• Monitor measure performance and forecast trends to support Star ratings and HEDIS performance improvement
• Translate measure specifications from NCQA, CMS, and other regulatory bodies into technical queries and reporting logic
• Support annual HEDIS reporting cycles, including chart abstraction, data submission, and audit preparation
• Track regulatory changes and ensure reporting compliance, as well as compliance with data governance, privacy and security standards
• Maintain a catalog of operational reports as related to NCQA, state, federal or other regulatory bodies, including specifications, frequency and submission guidelines. Monitor requirements for changes and revise reports as needed
• Support regulatory, accreditation and compliance activities as needed

Skills

• Bachelor's degree in Health Informatics, Data Science, Public Health, Statistics, or related field (Master's preferred)
• 3+ years of experience in managed care and healthcare analytics, including HEDIS and Stars programs
• 3 or more years of experience as a data programmer in a relational database environment including SAS, MS Access, SSRS and Tableau
• Proficiency in SQL and data visualization tools (e.g., Tableau, Power BI, Quicksight)
• Advanced proficiency in excel (pivot tables, VLOOKUP, Power Query)
• Experience with data quality assurance and healthcare data sources (claims, EMR, lab, pharmacy)
• 4 years of progressively responsible experience in data modeling, informatics and analysis
• Proficiency preparing spreadsheets, graphs and other visual presentation materials
• Successful completion of pre-employment background check
• Familiarity with NCQA, CMS Stars, ICD-10, CPT, DRGs and other associated medical coding standards
• Excellent communication skills (written and verbal), with the ability to explain complex data to non-technical audiences
• Strong analytical and problem-solving skills including but not limited to interpreting alpha-numeric data and identifying outliers and trends
• Understands testing methodologies for functional, systems, integration, performance and UAT
• Proficient in compiling information from multiple sources
• Attention to detail with excellent proof reading and editing skills
• Ability to work independently and collaboratively in a fast-paced environment
• Ability to meet deadlines, multi-task, and problem-solve in a fast-paced environment with changing priorities
• Ability to manage relationships with internal and external contacts
• Ability to work effectively both independently and within a collaborative team
• Experience with system integration projects including conversion, transitioning and consolidating business to new application platforms

Benefits

• Medical
• Dental
• Vision
• Pharmacy
• Merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• Paid time off
• Career advancement opportunities
• Resources to support employee and family wellbeing

Company Overview

• A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire. It was founded in 1997, and is headquartered in Boston, Massachusetts, US, with a workforce of 1001-5000 employees. Its website is https://wellsense.org.

Company H1B Sponsorship

• WellSense Health Plan has a track record of offering H1B sponsorships, with 1 in 2025, 8 in 2024, 2 in 2023, 2 in 2021, 1 in 2020. Please note that this does not guarantee sponsorship for this specific role.