Lead Data Analyst, Medicare Stars & Quality Analytics

Molina Healthcare•Long Beach, CA

About The Position

The Lead Data Analyst serves as a senior individual contributor responsible for complex healthcare analytics supporting Medicare Stars, provider incentive programs, member outreach campaigns, and enterprise performance reporting. This role requires advanced analytical skills, healthcare domain expertise, and the ability to independently lead complex analyses with minimal oversight. The Lead Data Analyst partners with business leaders, quality teams, operational teams, and vendors to identify opportunities for improving Medicare Star Ratings, closing care gaps, evaluating intervention effectiveness, and supporting provider performance initiatives. The position is responsible for developing member outreach target lists, performing ROI analyses, building executive dashboards, and delivering actionable insights that directly impact plan performance and financial outcomes.

Requirements

Bachelor's degree in health informatics, data science or related field, or equivalent combination of education and experience
5-7 years of experience in healthcare analytics, data analysis, reporting, or related field.
Demonstrated ability to independently lead complex analytical projects with minimal supervision.
Strong SQL querying skills (complex joins, window functions, CTEs, working with large datasets)
Experience developing dashboards and reporting solutions using Power BI.
Experience working with healthcare claims, membership, provider, and clinical data.
Experience performing root cause analysis and translating findings into business recommendations.
Experience supporting UAT testing and validating analytical and reporting outputs.
Advanced Microsoft Excel skills.

Nice To Haves

Experience with HEDIS measures, HEDIS reporting, and care gap identification is highly preferred.
Medicare Stars program experience is highly preferred.
CMS reporting and regulatory knowledge.
Provider incentive, pay-for-performance, or value-based care analytics experience.
Experience conducting campaign effectiveness and ROI analyses.
Experience creating Power BI Paginated Reports.
Experience using Python for automation and data analysis.
SharePoint and Power Automate experience.
Master's Degree or equivalent combination of education and experience
7-10+ years of experience in healthcare analytics, data analysis, reporting, or related field.

Responsibilities

Independently design and execute complex analyses supporting Medicare Stars, provider incentive programs, quality improvement initiatives, and enterprise reporting.
Develop member-level targeting and outreach lists using business-defined criteria, measure-level gap information, claims data, and other member attributes.
Evaluate the effectiveness and return on investment (ROI) of outreach, engagement, and quality improvement programs.
Analyze CMS Star Ratings, measure performance, and market benchmarks to identify opportunities for performance improvement.
Perform provider performance and pay-for-performance analyses to support incentive programs and provider reporting.
Develop, maintain, and enhance dashboards, scorecards, and reporting solutions using Power BI and other reporting tools.
Write, optimize, and validate complex SQL queries utilizing CTEs, window functions, complex joins, and other advanced techniques to support reporting and analytics.
Integrate, validate, and analyze data from multiple healthcare data sources, including claims, enrollment, provider, pharmacy, clinical, HEDIS, and CMS datasets.
Partner with business stakeholders to gather requirements, translate business needs into analytical solutions, and deliver actionable insights to support decision-making.
Communicate analytical findings and recommendations to technical and non-technical audiences while ensuring the accuracy, quality, and integrity of reporting deliverables.