Note: The job is a remote job and is open to candidates in USA. Capital Blue Cross is dedicated to improving the health and well-being of its members and communities. They are seeking a HEDIS Performance Analytics Lead who will be responsible for driving HEDIS improvement initiatives through advanced data analytics, identifying performance gaps, and quantifying the impact of interventions.
Responsibilities
- Lead the development of predictive models to identify members at risk of care gaps and prioritize outreach opportunities
- Perform advanced statistical analyses to uncover drivers of HEDIS performance variation
- Develop segmentation strategies (provider, population, geography) to target high-impact interventions
- Design forecasting models to project HEDIS performance and simulate intervention scenarios
- Translate complex analytical findings into clear, actionable recommendations for executive and operational stakeholders
- Identify the highest-value opportunities for improvement based on impact, feasibility, and ROI
- Serve as the primary advisor on HEDIS performance trends, risks, and opportunities
- Establish frameworks to measure the effectiveness of HEDIS interventions and initiatives
- Conduct pre/post and longitudinal analyses to evaluate program impact
- Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost of care implications
- Design and oversee enterprise HEDIS performance dashboards and reporting tools
- Partner with Analytics and Reporting HEDIS Technical team to ensure data quality, integration, and accessibility
- Automate reporting and insight generation to enable real-time performance monitoring
- Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs
- Enable stakeholders with data, tools, and insights to execute targeted improvement initiatives
- Present findings and recommendations to senior leadership with clarity and influence
- Maintain deep expertise in HEDIS specifications, including hybrid and administrative measures
- Identify opportunities to improve measure capture, coding accuracy, and documentation through analytics
- Support audit readiness through data validation and performance reconciliation
Skills
- 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement
- Advanced analytical skills, including experience with predictive modeling, statistical analysis, and large datasets
- Demonstrated ability to translate data into actionable insights that drive measurable outcomes
- Proficiency in data tools and programming languages (e.g., SQL, Python, R)
- Experience with data visualization tools (e.g., Tableau, Power BI)
- Master's degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field
- Experience with NCQA HEDIS measures and reporting processes
- Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models
- Experience working with claims, EHR, and supplemental data sources
Benefits
- Medical, Dental & Vision coverage
- A Retirement Plan
- Generous time off including Paid Time Off, Holidays, and Volunteer time off
- An Incentive Plan
- Tuition Reimbursement
- A flexible environment where your health and wellbeing are prioritized
- Investing heavily in training and continuing education
Company Overview
Company H1B Sponsorship