HEDIS Performance Analytics Lead

Capital Blue Cross • Harrisburg, PA

1d

About The Position

This senior-level analyst powers HEDIS improvement initiatives through advanced data analytics and insight generation. The role owns the end-to-end analytical framework for identifying performance gaps, prioritizing opportunities, and quantifying the impact of interventions. It combines Medicare/Stars HEDIS expertise, advanced analytics, and cross-functional leadership to drive measurable performance improvement.

The role develops predictive models, analyzes HEDIS performance, and translates findings into actionable recommendations for executive and operational stakeholders. It also establishes measurement frameworks for interventions, quantifies quality and financial outcomes, and oversees enterprise HEDIS dashboards and reporting. The position partners with Clinical, Quality, Provider Engagement, Operations, and analytics teams, and supports measure optimization, data validation, and audit readiness.

Requirements

• 7–10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement.
• Advanced analytical skills, including predictive modeling, statistical analysis, and working with large datasets.
• Demonstrated ability to translate data into actionable insights that drive measurable outcomes.
• Proficiency in data tools and programming languages such as SQL, Python, or R.
• Experience with data visualization tools such as Tableau or Power BI.

Nice To Haves

• Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or a 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.

Responsibilities

• Lead development of predictive models to identify members at risk of care gaps and prioritize outreach.
• Perform statistical analyses to identify drivers of HEDIS performance variation.
• Develop provider, population, and geographic segmentation strategies for targeted interventions.
• Design forecasting models to project HEDIS performance and simulate intervention scenarios.
• Translate analytical findings into actionable recommendations for executive and operational stakeholders.
• Identify high-value improvement opportunities based on impact, feasibility, and ROI.
• Advise 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 the Analytics and Reporting HEDIS Technical team to support data quality, integration, and accessibility.
• Automate reporting and insight generation for real-time performance monitoring.
• Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs.
• Equip stakeholders with data, tools, and insights to execute improvement initiatives.
• Present findings and recommendations to senior leadership.
• Maintain expertise in HEDIS specifications, including hybrid and administrative measures.
• Use analytics to identify opportunities to improve measure capture, coding accuracy, and documentation.
• Support audit readiness through data validation and performance reconciliation.

Benefits

• Medical, dental, and vision coverage.
• Retirement plan.
• Paid time off, holidays, and volunteer time off.
• Incentive plan.
• Tuition reimbursement.
• Flexible work environment.
• Training and continuing education.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed