HEDIS Data Analyst – Architect, Healthcare Payer

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Provide support for HEDIS measurement, reporting, validation, and annual submission activities.

• Analyze and interpret HEDIS measure specifications, translating business requirements into effective data and reporting solutions.

• Evaluate HEDIS performance results to identify areas for enhancing quality scores and closing care gaps.

• Contribute to the architecture of HEDIS solutions, which includes designing data flows, integration strategies, reporting architectures, and recommending scalable data models.

• Collaborate with technical architects and engineering teams to ensure HEDIS reporting requirements align with platform capabilities, data governance standards, and long-term architectural decisions.

• Work alongside quality, population health, provider engagement, and care management teams to advance HEDIS initiatives.

• Assist in HEDIS audits, documentation reviews, and quality assurance processes.

• Collect, analyze, document, and validate business requirements from healthcare plan stakeholders.

• Conduct root cause analysis on data quality issues affecting HEDIS, CMS reporting, and operational performance.

• Create source-to-target mappings, business rules, process flows, and functional specifications.

• Analyze extensive healthcare datasets, presenting findings, trends, and recommendations to business stakeholders.

• Provide support for UAT testing, reconciliation, defect resolution, and deployment validation processes.

• Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data for HEDIS and CMS reporting.

• Validate the completeness and accuracy of data, reconciliation results, and reporting outputs.

• Contribute to CMS quality initiatives, STAR Ratings programs, and regulatory reporting obligations.

• Collaborate with both business and technical teams to enhance reporting processes and data governance practices.

• Gain an understanding of payer operational workflows, including claims processing, provider data, membership, enrollment, and quality management programs.

• Engage directly with Huron consultants and client stakeholders to address complex payer data challenges.

• Facilitate requirements sessions, stakeholder interviews, and process reviews.

• Translate technical findings into actionable business recommendations and executive-level communications.

• Support the execution of strategic payer transformation and data modernization initiatives.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or a related field; relevant work experience may be considered in lieu of a degree.

• 4–6+ years of experience in healthcare payer, health plan, or managed care settings.

• Experience in supporting solution design, architecture documentation, technical requirements, or data platform modernization for HEDIS, quality reporting, or payer analytics solutions.

• Familiarity with healthcare data architecture concepts, including source-to-target mapping, data lineage, integration design, reporting architecture, and scalable data model design.

• Strong practical knowledge of HEDIS and experience in supporting HEDIS reporting initiatives.

• Experience within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment.

• Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements.

• Experience analyzing claims, encounters, membership/eligibility, provider data, pharmacy data, and supplemental clinical data.

• Strong business analysis skills, including requirements gathering, process documentation, and stakeholder management.

• Advanced SQL skills for healthcare data analysis and validation.

• Experience conducting data quality reviews, reconciliations, and root cause analyses.

• Excellent communication and presentation skills.

• Applicants must be U.S. Citizens.

• Unable to consider H-1B, C2C, or 1099 candidates.

🏝️ Benefits

• Medical, dental, and vision coverage for employees and their dependents.

• 401(k) plan featuring a generous employer match.

• Employee stock purchase plan.

• Generous Paid Time Off policy.

• Paid parental leave.

• Adoption assistance.

• Wellness Program offering free annual health screenings and coaching.

• Bank at work.

• On-site workshops.

• Ongoing programs recognizing significant life events of employees.