HEDIS & Stars Analyst

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The HEDIS and Stars Analyst is responsible for driving performance improvement through data analysis, visualization, and strategic insights. This role supports the organization's quality initiatives by managing HEDIS, Medicare Stars and other quality measure data, developing dashboards, and identifying actionable trends to improve clinical outcomes and ensure compliance with regulatory and accreditation requirements.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

Data Analysis & Manipulation

• 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.

Dashboard Development

• 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

Insight Generation

• 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.

HEDIS, Stars & Quality Program Support

• 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

Supervision Exercised:

• None

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education Required:

• Bachelor's degree in Health Informatics, Data Science, Public Health, Statistics, or related field (Master's preferred).

Experience Required:

• 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

Experience Preferred/Desirable:

• Experience with system integration projects including conversion, transitioning and consolidating business to new application platforms

Required Licensure, Certification or Conditions of Employment:

• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• 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

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

Compensation Range

$72,500- $105,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees