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)
  
  
  
  
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  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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Job Tags

Remote work

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