Position:Principal Quality Analytics Lead
Position Summary:Responsible for designing, building, validating, and operationalizing quality analytics capabilities to improve Medicare Advantage Stars performance, HEDIS outcomes, and clinical quality. Serves as a senior, hands-on analytics builder and subject matter expert on Stars and HEDIS, working independently to translate complex health plan data into actionable performance insights. Directly impacts Quality Improvement strategy by building the analytic assets required to identify performance gaps, reduce manual reporting, and drive measurable improvement across all Stars and HEDIS measures in accordance with CMS guidelines.
Job Description:Primary Responsibilities:- Design, build, and maintain CMS-aligned Stars/HEDIS analytic assets, including dashboards, data extracts, recurring performance views, and executive-ready reporting products.
- Translate measure specifications (numerator, denominator, exclusions) into auditable analytic logic and develop member-, provider-, and measure-level views to guide Quality Improvement actions.
- Analyze multi-source data (quality, medical, pharmacy, clinical) to establish baselines, detect trends, uncover root causes of performance gaps, and distinguish data issues from operational issues.
- Partner with Quality Improvement, Clinical, Pharmacy, and Operations stakeholders to prioritize high-impact opportunities and convert analytic insights into intervention targeting, workflow integration, and measurable gap closure.
- Automate and scale recurring quality reporting to reduce manual effort through scalable dashboards, reusable SQL, documented logic, and repeatable processes.
- Create and manage validation routines, QA checks, and reconciliation processes to ensure quality reporting is accurate, trusted, reproducible, and audit-ready.
- Translate complex technical and measure logic into clear, decision-ready performance narratives for non-technical stakeholders and health plan leadership.
- Serve as a senior subject matter expert on Stars, HEDIS, quality measure reporting, and health plan operations, advising on the workflow integration of analytic insights.
Qualifications:- Bachelor's degree in Mathematics, Computer Science, Epidemiology, Public Health, Healthcare Administration, Data Analytics, or a related field; equivalent experience may be considered.
- 7+ years of healthcare analytics experience, with direct experience in Medicare Advantage Stars, HEDIS, quality measures, and health plan performance analytics.
- Hands-on experience writing complex SQL and extracting data from large, multi-layered health plan data environments.
- Experience building dashboards, recurring reports, or automated reporting processes using Tableau, Power BI, or similar business intelligence tools.
- Experience with Stars cut points, HEDIS specifications, CAHPS, medication adherence, clinical quality workflows, or care gap closure.
- Ability to translate Stars/HEDIS measure logic into analytic rules, including numerators, denominators, exclusions, and opportunity sizing.
- Experience working with healthcare datasets such as claims, eligibility, provider, pharmacy, or clinical data.
- Demonstrated ability to self-direct analyses, manage ambiguity, structure complex problems, and deliver actionable insights with limited direction.
- Experience using AI-enabled analytics, automation, or natural language tools to accelerate insight generation.
- Strong communication skills with the ability to explain technical concepts and recommended actions to non-technical stakeholders.
- Advanced degree in Public Health, Epidemiology, Analytics, Computer Science, Healthcare Administration, or a related field.
Working Conditions- While performing the duties of this job, the employee works in normal office working conditions.
#LI-REMOTE
Pay Transparency:Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.
The hiring range for this position is:
$133,200.00-$180,900.00
Benefits of working at Lumeris
- Medical, Vision and Dental Plans
- Tax-Advantage Savings Accounts (FSA & HSA)
- Life Insurance and Disability Insurance
- Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
- Employee Assistance Program
- 401k with company match
- Employee Resource Groups
- Employee Discount Program
- Learning and Development Opportunities
- And much more...
Be part of a team that is changing healthcare!
Member Facing Position: No- Not Member or Patient Facing Position
Location:Remote, USA
Time Type:Full time
