HEDIS Performance Analytics Lead

Capital Blue Cross

. Lead predictive modeling to identify members at risk of care gaps and prioritize outreach .

Posted 11/3/2026full-timeRemote • Pennsylvania • United StatesSenior💰 $86,710 - $161,040 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced analytical skills in healthcare analytics, focusing on predictive modeling, statistical analysis, and HEDIS performance improvement. Proficient in translating complex data into actionable insights for executive stakeholders, with a strong emphasis on quality outcomes and financial implications.

Highest-signal resume keywords

Healthcare Analytics ExperiencePredictive ModelingSQL ProficiencyHEDIS ExpertiseStatistical Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Predictive ModelingStatistical AnalysisData AnalysisLarge DatasetsHEDIS Performance ImprovementFinancial Outcome QuantificationQuality Outcome MeasurementData ValidationIntervention Effectiveness MeasurementLongitudinal Program Impact Analysis

Soft Skills

CollaborationCommunicationStakeholder EngagementInsight TranslationPresentation Skills

Tools & Technologies

SQLPythonRTableauPower BI

Industry Keywords

HEDISMedicare StarsMedicaid Quality ProgramsValue-Based Care ModelsNCQA HEDIS MeasuresClaims DataEHRSupplemental Data Sources

Tech Stack

Tools & technologies

PythonSQLTableau

About the role

Key responsibilities & impact

Lead predictive modeling to identify members at risk of care gaps and prioritize outreach
Perform statistical analyses to identify drivers of HEDIS performance variation
Develop provider, population, and geographic segmentation strategies
Design forecasting models and simulate intervention scenarios
Translate analytical findings into recommendations for executive and operational stakeholders
Identify high-value improvement opportunities based on impact, feasibility, and ROI
Advise on HEDIS performance trends, risks, and opportunities
Establish frameworks to measure HEDIS intervention effectiveness
Conduct pre/post and longitudinal program-impact analyses
Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost-of-care implications
Design and oversee enterprise HEDIS dashboards and reporting tools
Partner with the Analytics and Reporting HEDIS Technical team on data quality, integration, and accessibility
Automate reporting and insight generation for real-time performance monitoring
Collaborate with Clinical, Quality, Provider Engagement, and Operations teams
Enable stakeholders with data, tools, and insights for targeted improvement initiatives
Present findings and recommendations to senior leadership
Maintain expertise in HEDIS specifications, including hybrid and administrative measures
Identify opportunities to improve measure capture, coding accuracy, and documentation
Support audit readiness through data validation and performance reconciliation

Requirements

What you’ll need

7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement
Advanced analytical skills, including predictive modeling, statistical analysis, and large datasets
Ability to translate data into actionable insights that drive measurable outcomes
Proficiency in SQL, Python, or R
Experience with Tableau or Power BI
Experience with NCQA HEDIS measures and reporting processes preferred
Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models preferred
Experience working with claims, EHR, and supplemental data sources preferred
Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field preferred

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Flexible environment
Training and continuing education
Professional and personal growth opportunities
Community volunteering opportunities