Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures.
Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions.
Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners.
Model future projections and perform “What-if” scenarios for STAR rating forecasts.
Conduct routine process analysis for department’s operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks.
Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies.
Track performance of interventions and provide data-driven insights on progress and effectiveness.
Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities.
Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies.
Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes.

Requirements

Experience as a Senior Quality Analyst within a health plan or healthcare organization working with a STAR program is highly desirable.
Bachelor's Degree or equivalent experience required.
Master’s degree in a related field preferred.
Experience working within a health plan STAR team.
Familiarity with claims, encounter, and EMR data.
Experience supporting provider engagement or quality improvement initiatives.
Strong knowledge of CMS STAR Ratings methodology, HEDIS measures, CAHPS, HOS, and Medicare Advantage quality programs.
Advanced proficiency in data analysis tools (Excel, SQL, Python, SAS, R, Tableau, or Power BI).
Proficient with MS Office (Access, Word, Excel, PowerPoint) and e-mail.
Ability to communicate complex analytical information to diverse audiences.
Analytical Thinking and Problem-Solving - excel in breaking down complex information and deriving actionable insights.
Strong organizational and project management skills.
Ability to work independently and in a team environment.
Strong team player.
Ability to work under tight deadlines & manage multiple responsibilities independently.

Benefits

Internal title: STARS Quality Analyst Sr
Work Mode: Mostly Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!

Applicant Tracking System Keywords

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

Hard Skills & Tools

data analysisroot-cause analysisquality improvementSTAR ratings methodologyHEDIS measuresCAHPSHOSclaims dataEMR dataperformance tracking

Soft Skills

analytical thinkingproblem-solvingcommunicationorganizational skillsproject managementteam collaborationindependencetime managementadaptabilityinterpersonal skills