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.
Collaborate with internal 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.
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.

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

Benefits

Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLPythondata analysispredictive modelingforecastingdata manipulationperformance metrics analysisdashboard developmentdata quality assurancestatistical analysis

Soft Skills

collaborationattention to detailproject managementvendor managementstrategic thinkingcommunicationorganizational skillsleadershipproblem-solvingquality improvement