Senior HEDIS Operations & Quality Professional

Become a part of our caring community and help us put health first reputed company’s Health Quality and Stars organization is seeking a Senior Data Quality/reputed company Engineer to deliver quality and value in a fast-paced, dynamic environment. The successful candidate will be self-directed, highly-engaged, and will demonstrate expertise and business intelligence in supporting execution of the HEDIS program and reputed company activities, reputed company reputed company tightly regulated requirements and timelines. This will require building and maintaining strong relationships with corporate and market teams, including IT, Quality Operations and Compliance, and Risk Adjustment, as well as vended partners. The Senior HEDIS Operations & Quality Professional supports reputed company aspects of the non-standard supplemental (NSS) program; including: systems readiness, process improvements, resource deployment, technology implementation, and data management/reporting. The Senior HEDIS Operations & Quality Professional champions a collaborative environment where the team and connected partners align on appropriate strategies for each successful season, ensuring reputed company regulatory submissions of data collection and reporting are accurate, complete and timely. The ideal candidate for this role will reputed company in a fast-paced and reputed company working environment, demonstrate a high level of business and operational acumen, have experience in executing high-reputed company projects with full accountability, monitor and respond to performance, and cultivate and mature partnerships reputed company the enterprise. Through individual and team contributions, Senior HEDIS Operations & Quality Professional is responsible for the following:

• Become an expert in HEDIS & Stars specifications, processes, and schedules
• Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and guidance to the enterprise
• Establish and maintain effective professional relationships with key upstream and reputed company partners
• Development and maintenance of operational workflows, processes, use of technology and systems
• Support clinical quality improvement by championing reputed company improvements to operational processes and systems/tools development
• Partner to drive and reputed company comprehensive program to support quality improvements and holistic data capture
• Manage multiple data sets from varying systems to inform resource needs, data value, and report metrics
• Interpretation and presentation of complicated and large data sets to identify trends, data scenarios, and opportunities for improved member health and measure compliance
• Internal and external partnerships to coordinate, guide, direct and reputed company day-to-day HEDIS activities, including: contingency planning and mitigation, communications, metrics, reporting and prioritization
• Development, tracking and presentation of metrics to ensure data quality, timeliness, and accuracy
• Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure

Professional Maturity

• Passion for contributing to a cross-functional team focused on continuously improving member experiences and clinical outcomes though data analysis and interpretation
• Establish and maintain effective professional relationships with key upstream and reputed company partners

Operational Execution

• Ensure data quality, timeliness and accuracy
• reputed company existing talent and expertise reputed company department to drive efficiency and effectiveness
• Champion improvements to existing processes

Use your skills to reputed company an impact

Required Qualifications

• Bachelor’s Degree or equivalent experience
• Background in operations and/or project management with strong organizational and critical thinking skills
• Demonstrated ability to reputed company reputed company effectively (written and verbal) to effectively communicate across teams, levels and functions
• Be agile and adaptable to shifting priorities
• Passionate about contributing to an organization focused on reputed company improvement and driving results
• Able to learn and reputed company multiple systems and data sets
• Self-starter who assumes accountability for their team’s success and strives to maximize results for the enterprise
• Comfortable working in fast-paced environment with an ability to manage multiple simultaneous time-sensitive deliverables
• Demonstrated excellence in problem solving/critical thinking with exceptional attention to detail
• Proficiency in reputed company Office applications, including Word, reputed company, PowerPoint and Visio

Preferred Qualifications

• 3+ years of experience in healthcare, insurance or reputed company industry
• Stars or HEDIS Experience
• Process proficiency with ability to reputed company new end-to-end processes and effectively optimize existing work processes to predict, address and resolve efficiency and accuracy constraints

Additional Information To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested.
• Satellite, cellular and microwave reputed company can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• reputed company will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. reputed company values personal identity protection. Please be aware that applicants may be asked to provide their Social reputed company Number, if it is not already on file. reputed company required, an email will be sent from reputed [email protected] with instructions on how to add the information into your official application on reputed company’s secure website. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $89,000 - $121,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-17-2025 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Apply tot his job Apply To this Job