HEDIS Data Analyst | Architect - Healthcare Payer

Huron • Chicago, IL

6d • $60 - $70 • Remote

About The Position

Huron is a global consultancy that collaborates with clients to drive strategic growth, ignite innovation and navigate constant change. Through a combination of strategy, expertise and creativity, we help clients accelerate operational, digital and cultural transformation, enabling the change they need to own their future. Huron's HDTx Payer Services team partners with health plans to improve quality performance, regulatory compliance, operational efficiency, and member outcomes through data-driven transformation. We are seeking a HEDIS Data Analyst | Architect - Healthcare Payer with 4–6+ years of healthcare payer experience and strong expertise in HEDIS reporting, CMS quality programs, healthcare claims data, payer operations, and the ability to contribute to solution architecture discussions for HEDIS reporting and payer data modernization initiatives. The ideal candidate will possess hands-on experience working within a health plan or healthcare payer environment and demonstrate the ability to analyze, validate, and transform healthcare data into actionable insights that support HEDIS, CMS STARs, quality improvement, and regulatory reporting initiatives. This role serves as a bridge between business stakeholders, quality teams, operational leaders, and technical teams to ensure accurate and compliant reporting while contributing to scalable solution design, data architecture, and measurable performance improvements.

Requirements

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field. Additional relevant work experience in lieu of degree may be considered.
• 4–6+ years of healthcare payer, health plan, or managed care experience.
• Experience supporting solution design, architecture documentation, technical requirements, or data platform modernization efforts for HEDIS, quality reporting, or payer analytics solutions.
• Exposure to healthcare data architecture concepts, including source-to-target mapping, data lineage, integration design, reporting architecture, and scalable data model design.
• Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives.
• Experience working 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 healthcare data including: Claims, Encounters, Membership/Eligibility, Provider Data, Pharmacy Data, Supplemental Clinical Data
• Strong business analysis skills including requirements gathering, process documentation, and stakeholder management.
• Advanced SQL experience for healthcare data analysis and validation.
• Experience performing data quality reviews, reconciliations, and root cause analysis.
• Strong communication and presentation skills.
• Applicants must be U.S. Citizens, and we are unable to consider H-1B, C2C, or 1099 candidates.

Responsibilities

• Support HEDIS measurement, reporting, validation, and annual submission activities.
• Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions.
• Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps.
• Contribute to HEDIS solution architecture activities, including data flow design, integration approach, reporting architecture, and scalable data model recommendations.
• Partner with technical architects and engineering teams to align HEDIS reporting requirements with platform capabilities, data governance standards, and long-term architecture decisions.
• Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives.
• Assist with HEDIS audits, documentation reviews, and quality assurance activities.
• Gather, analyze, document, and validate business requirements from health plan stakeholders.
• Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance.
• Develop source-to-target mappings, business rules, process flows, and functional specifications.
• Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders.
• Support UAT testing, reconciliation, defect resolution, and deployment validation activities.
• Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting.
• Validate data completeness, accuracy, reconciliation results, and reporting outputs.
• Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements.
• Collaborate with business and technical teams to improve reporting processes and data governance practices.
• Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs.
• Work directly with Huron consultants and client stakeholders to solve complex payer data challenges.
• Facilitate requirements sessions, stakeholder interviews, and process reviews.
• Translate technical findings into business recommendations and executive-level communications.
• Support delivery of strategic payer transformation and data modernization initiatives.

Benefits

• medical, dental, and vision coverage to employees and dependents
• a 401(k) plan with a generous employer match
• an employee stock purchase plan
• a generous Paid Time Off policy
• paid parental leave and adoption assistance
• Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year.

What This Job Offers

• Career Level: Mid Level