The JobThe
Senior Quality Analyst is a key contributor to the Medicare Advantage STAR Program, responsible for analyzing performance data, supporting quality improvement initiatives, managing measure-level interventions, interpretations, and ensuring the organization meets CMS STAR rating goals. This role provides advanced analytical expertise, cross-functional collaboration, and operational support to drive improvements in clinical quality, customer experience, pharmacy measures, and operational compliance. The Analyst must stay current on CMS rules, technical specifications, and methodological changes
related to STAR Ratings, HEDIS, CAHPS, and Medicare Advantage.
You Will- Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures.
- Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions.
- Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners.
- Model future projections and perform "What-if" scenarios for STAR rating forecasts.
- Conduct routine process analysis for department's operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks.
- Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies.
- Track performance of interventions and provide data-driven insights on progress and effectiveness.
- Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities.
- Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies.
- Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes.
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
- Actively support the achievement of SCAN's Vision and Goals.
- Other duties as assigned.
Your Qualifications- Experience as a Senior Quality Analyst within a health plan or healthcare organization working with a STAR program is highly desirable.
- Bachelor's Degree or equivalent experience required.
- Master's degree in a related field preferred.
- Experience working within a health plan STAR team.
- Familiarity with claims, encounter, and EMR data.
- Experience supporting provider engagement or quality improvement initiatives.
- Strong knowledge of CMS STAR Ratings methodology, HEDIS measures, CAHPS, HOS, and Medicare Advantage quality programs.
- Advanced proficiency in data analysis tools (Excel, SQL, Python, SAS, R, Tableau, or Power BI).
- Proficient with MS Office (Access, Word, Excel, PowerPoint) and e-mail.
- Ability to communicate complex analytical information to diverse audiences.
- Analytical Thinking and Problem-Solving - excel in breaking down complex information and deriving actionable insights.
- Strong organizational and project management skills.
- Ability to work independently and in a team environment. Strong team player.
- Ability to work under tight deadlines & manage multiple responsibilities independently.
What's in it for you?- Base salary range: $71,700 to $103,732 per year
- Internal title: STARS Quality Analyst Sr
- Work Mode: Mostly Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
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