We’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. We are delivering the right care how and when it’s needed; providing support to make smarter and healthier choices; and making prescription services easier, while helping you save money along the way. It’s everything health care should be. Together, for better health.

The Senior Value-Based Healthcare Data Analyst is responsible for providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions. This position ensures accuracy, integrity, traceability, and compliance of complex, multi source healthcare data in accordance with NCQA, CMS, and state regulatory requirements. The role functions as a hands on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams. Through collaboration and data driven insights, the position supports organizational objectives related to quality performance, affordability, and improved member outcomes.

Required Qualifications:

Bachelor's degree in Health Informatics, Healthcare Administration, Data Analytics, Statistics, Computer Science, Information Systems, Mathematics, or a related discipline

3+ years of experience in healthcare data analytics, informatics, decision support, or managed care, including project leadership or analyst mentoring

Experience supporting NCQA HEDIS Compliance Audits, quality measurement, and value-based care programs

Experience supporting Medicare Advantage (Part C) and/or Health Insurance Marketplace products

Experience extracting, reconciling, and validating data from EPIC Clarity and/or Caboodle

Solid experience with data validation, ETL processes, and healthcare reporting tools (eg, Tableau, Power BI, Crystal Reports)

Knowledge of Medicare Advantage, including Stars, HEDIS, and regulatory reporting programs

Advanced expertise in healthcare data analytics, quality measurement, and regulatory compliance

Understanding of HEDIS Technical Specifications, NCQA requirements, and related compliance standards

Proficiency working with claims and clinical data, including ICD 10 CM and CPT/HCPCS coding standards and healthcare data models

Advanced proficiency in SQL and Microsoft Excel, with working knowledge of Word and PowerPoint

Demonstrated ability to translate complex healthcare data into clear, executive level insights that support quality and performance strategy

Demonstrated ability to manage multiple priorities in a fast paced, deadline driven environment

Proven verbal and written communication skills with exceptional attention to detail and analytical rigor

Proven independently monitors data pipelines, submissions, and measure results for anomalies, gaps, or logic errors

Preferred Qualifications:

Master's degree in health informatics, Data Science, Analytics, Biostatistics, Healthcare Administration, or related field

Relevant certifications such as CPHQ, RHIA/RHIT, Epic (Clarity/Caboodle/reporting), CAP, or SAS/SQL/data analytics

3+ years of experience with EDI encounter data (837), acknowledgments (277CA/999), and CMS risk adjustment files (MAO 002/004, RAPS)

Experience reviewing work and providing actionable feedback

Solid expertise in healthcare analytics, quality metrics, and value-based care models

Advanced knowledge of Epic Clarity architecture, refresh cycles, and EDW integration for BI/reporting

Proficiency in Python, R, SAS, or similar programming/statistical tools

Demonstrated ability to balance strategic thinking with hands-on execution

Proven problem-solving skills with a focus on continuous improvement and proactive solution development