Hi Professionals,
Title: HEDIS Analyst/Consultant
Locattion: Remote
JD:
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)
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
HEDIS Analyst/Consultant1HEDIS Analyst/Consultant,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 ModernizaN/AC2CUnited States