Medicare Stars & Quality Program Analyst

Role Description

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 existing 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.

Qualifications

• 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.

Requirements

• Ability to communicate and summarize complex data processes, findings, etc. in a simple and clear way to a non-technical savvy audience.
• Excellent verbal communication and interpersonal skills.
• Excellent interpersonal skills with proven success in building and maintaining strong relationships with internal & external stakeholders.
• Excellent ability to 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.
• Advanced 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.
• Problem-solving 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.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must occasionally lift and/or move up to 5 pounds.