WellSense Health Plan ยท 3 days ago
HEDIS & Stars Analyst
United States
Full-time
Remote
Mid Level
$72K/yr - $105K/yr
3+ years expWellSense 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.
Hospital & Health Care
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
Qualification
Required
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
Preferred
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
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase