HEDIS Performance Analytics Lead

Lead the development of predictive models to identify members at risk of care gaps and prioritize outreach opportunities.

Perform advanced statistical analyses to uncover drivers of HEDIS performance variation.

Develop segmentation strategies (provider, population, geography) to target high-impact interventions.

Design forecasting models to project HEDIS performance and simulate intervention scenarios.

Translate complex analytical findings into clear, actionable recommendations for executive and operational stakeholders.

Identify the highest-value opportunities for improvement based on impact, feasibility, and ROI.

Serve as the primary advisor on HEDIS performance trends, risks, and opportunities.

Establish frameworks to measure the effectiveness of HEDIS interventions and initiatives.

Conduct pre/post and longitudinal analyses to evaluate program impact.

Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost of care implications.

Design and oversee enterprise HEDIS performance dashboards and reporting tools.

Partner with Analytics and Reporting HEDIS Technical team to ensure data quality, integration, and accessibility.

Automate reporting and insight generation to enable real-time performance monitoring.

Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs.

Enable stakeholders with data, tools, and insights to execute targeted improvement initiatives.

Present findings and recommendations to senior leadership with clarity and influence.

Maintain deep expertise in HEDIS specifications, including hybrid and administrative measures.

Identify opportunities to improve measure capture, coding accuracy, and documentation through analytics.

Support audit readiness through data validation and performance reconciliation.

7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement.

Advanced analytical skills, including experience with predictive modeling, statistical analysis, and large datasets.

Demonstrated ability to translate data into actionable insights that drive measurable outcomes.

Proficiency in data tools and programming languages (e.g., SQL, Python, R).

Experience with data visualization tools (e.g., Tableau, Power BI).

Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field.

Experience with NCQA HEDIS measures and reporting processes.

Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models.

Experience working with claims, EHR, and supplemental data sources.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.