Senior Product Engineer – HEDIS SME

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

📋 Description

• Lead initiatives focused on data quality that influence HEDIS, CMS submissions, and the accuracy of regulatory reporting.

• Evaluate, identify, and address gaps in data, inconsistencies, and lineage challenges across payer systems.

• Enhance data validation, reconciliation, and reporting processes.

• Establish and execute data governance frameworks and standards in collaboration with stakeholders.

• Act as a Subject Matter Expert (SME) for HEDIS measures and the methodologies used in CMS STARs ratings.

• Convert regulatory requirements into functional and technical specifications.

• Assist in the measurement strategy, monitor performance, and optimize reporting to improve STARs outcomes.

• Provide guidance to payer clients on best practices for CMS data submission and reporting.

• Design and refine solutions utilizing Cognizant CMS Edge Server, Claimsphere, and core payer platforms such as Facets.

• Facilitate integration and data flow between claims, encounters, and reporting systems.

• Partner with engineering teams to create scalable reporting and analytics products.

• Create predictive models and analytics frameworks aimed at enhancing quality outcomes and STARs performance.

• Enable advanced analytics using payer data to uncover trends, risks, and opportunities.

• Transition reporting solutions into proactive, insights-driven platforms.

• Engage with business and executive stakeholders in a strategic advisory capacity.

• Convert business requirements into technical roadmaps and product solutions.

• Lead or participate in client-facing discussions, workshops, and design sessions.

• Collaborate with teams across data, IT, compliance, and business operations.

⛳️ Requirements

• 7–12+ years of experience in the healthcare payer sector.

• Extensive knowledge in HEDIS reporting.

• Profound understanding of CMS STARs methodology.

• Strong expertise in regulatory reporting and quality programs.

• Proven experience in data quality management, reporting, and analytics in payer environments.

• Solid grasp of claims and encounter data.

• Comprehensive understanding of the data lifecycle, validation, and reconciliation processes.

• Capability to engage business stakeholders and translate their requirements into effective solutions.

• Experience in client-facing consulting or product engineering environments.

• Excellent communication skills, with the ability to interface across both technical and non-technical teams.

• U.S. Citizenship is required.

• Must be eligible to work as a W2 hourly contract employee; H-1B, C2C, and 1099 candidates will not be considered.

🏝️ Benefits

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

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

• Employee stock purchase plan.

• A generous Paid Time Off policy.

• Paid parental leave.

• Adoption assistance.

• Wellness Program that includes free annual health screenings and coaching.

• Bank at work.

• On-site workshops.

• Ongoing programs that recognize significant events in employees’ lives.