Job Description
Hi Professionals,
Title: HEDIS Analyst/Consultant
Locattion: Remote
JD:
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Must-Have:
- US Healthcare Payer
- Actuarial
- Underwriting
- HEDIS / Quality
- Claims & Enrollment Data
- PMPM / MLR / IBNR / Risk Adjustment
- SQL & Data Profiling
- Data Lineage / Data Mapping
- Business Rule Discovery
- Reverse Engineering
- Healthcare Analytics / Data Modernization
- Snowflake (Preferred)
a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } Key Requirements:
- Strong US Healthcare Payer domain expertise
- Experience with Actuarial, Underwriting & HEDIS/Quality
- Knowledge of payer metrics: PMPM, MLR, IBNR, Risk Adjustment, Cost & Utilization
- Hands-on experience with Claims, Membership, Provider, Premium & Clinical data
- Strong SQL, Data Analysis & Data Profiling skills
- Ability to reverse engineer business rules, data flows, lineage & mappings
- Bridge communication between business SMEs and technical teams
- Healthcare analytics, transformation, or data modernization experience preferred
- Exposure to Snowflake, Semantic Modeling, Metadata Management, AI-enabled Analytics is a plus
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Numbers & Facts
| Location | NULL, CA (Remote) |
Skills
Actuarial Skillsunmatched
Analysis Skillsunmatched
Artificial Intelligence (AI)unmatched
Clinical Dataunmatched
Consultingunmatched
Data Analysisunmatched
Data Mappingunmatched
Data Profilingunmatched
Healthcareunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
Metadataunmatched
Metricsunmatched
Reverse Engineeringunmatched
Riskunmatched
SQL (Structured Query Language)unmatched
Underwritingunmatched
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