Medicare Stars & Quality Program Analyst

Capital Blue Cross•Harrisburg, PA

14h

About The Position

This role is responsible for supporting Capital Medicare Advantage Star Ratings Program analytics activities impacting the program strategy and operations. The Medicare Stars & Quality Program Analyst works closely with the Medicare Stars & Quality Program Director and Risk Adjustment team supporting the execution of the Program strategy through analysis and reporting tactics driving results to improve or maintain a minimum of 4+ overall Star Ratings for each Capital’s contracts year over year. This role requires strong domain expertise in Medicare Advantage STARS programs, coupled with hands-on experience in forecasting STARS performance and applying data-driven strategies to improve outcomes. The ideal candidate will also have foundational technical skills in Power BI, SQL, and Excel to support advanced reporting and predictive analysis. The role will include support in the development of reports, enhancement to exiting reports, data analysis, processes, and methodologies that will inform and enable the Medicare Stars Program leader(s) to make informed decisions based on data and drive the execution of the Program strategy and operations effectiveness.

Requirements

3 + years of experience working in a Medicare Advantage setting, with a minimum of 2 years focused on STARS performance management
Proficiency with Python SQL, MS Access, Excel, SAS, Power BI, and other query/reporting tools.
Strong understanding of CMS STARS methodology, including HEDIS, CAHPS, HOS, and operational measures.
Demonstrated experience with forecasting STARS performance, ideally using data models and predictive analytics.
Vendor management, Project Management, and/or Quality Improvement experience.
Ability to communicate and summarize complex data processes, findings, etc. in a simple and clear way to non-technical savvy audience.
Excellent verbal communication and interpersonal skills. Able to convey complex and/or technical information in a manner that others can understand.
Excellent interpersonal skills with proven success in building and maintaining strong relationships with internal & external stakeholders.
Excellent convert ideas into clear processes, reports, analysis, etc.
Advanced proficiency in spreadsheet, database and word processing software
Intermediate proficiency with data warehouses and query tools / design
Intermediate skill with data visualization tools, such as Tableau, and Power BI
Intermediate proficiency with development, testing, and management of Tableau Dashboards
Intermediate understanding of data management principles
Advanced skill in databases, spreadsheet, business intelligence, statistical, and data cubing software
Advance proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), Project Management tools, Teams/WebEx/ZOOM.
Advanced skills in mathematics and statistics
Proficiency in SAS Enterprise Business Intelligence software
Advanced understanding of data management principles
Analysis techniques: process flow/maps, data dictionary, data mapping, glossary, requirements review and validation, etc.
Adaptability to an agile and dynamic work environment.
Strong organization and documentation, attention to details, ability to handle multiple project tasks simultaneously, time management meeting deadlines, even under pressure. Eager to work with sense of urgency aligned with priorities, overcome obstacles, if needed seek for support early driving the best results to positive impact on the Company and team goals.
Problem solves and critical thinking mindset that’s oriented to find solutions.
Fast learner and eager to develop a solid understanding of quality measures considered within the Star Ratings Program.

Nice To Haves

Prefer bachelor’s degree in data Analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health, Health-related Sciences, Health Administration or Business Administration.

Responsibilities

Collaborate with internal stakeholders & teams (Quality, Clinical, Operations, A&R, among others) to drive action plans based on performance and forecast data.
Develop and maintain dashboards and performance tracking tools in Power BI and Excel to support ongoing monitoring and executive reporting.
Analyze Medicare STARS performance metrics including HEDIS, CAHPS, HOS, and operational measures to identify trends, gaps, and opportunities.
Lead or contribute to the forecasting of STARS ratings, using historical data, predictive modelling, and CMS methodology to project future performance.
Translate STARS forecast insights into strategic initiatives to optimize performance and achieve targeted ratings.
Write and optimize SQL queries to extract, manipulate, and analyze complex datasets from various sources.
Use Python for automating data processing tasks, generating forecasts, and conducting advanced analyses as needed.
Ensure accurate, timely reporting and alignment with evolving CMS requirements and regulatory updates.
Support audits, internal reviews, and CMS data submissions with high attention to data quality and integrity.
Collaborate with Actuarial to project and monitor the impact of the program on revenue for forecasting and financial statement accruals.
Assist during the creation of processes, documentation, reporting infrastructure, SOPs, audits, etc.