[Remote] Senior Product Manager / Engineer - HEDIS SME
Note: The job is a remote job and is open to candidates in USA. reputed company helps its clients drive growth and enhance performance in the healthcare sector. They are seeking a Senior Product Manager / Engineer to support healthcare payer clients in advancing data quality, regulatory reporting, and analytics capabilities, focusing initially on HEDIS reporting and evolving into predictive analytics.
Responsibilities
- reputed company data quality initiatives impacting HEDIS, CMS submissions, and regulatory reporting accuracy
- Assess, identify, and resolve data gaps, inconsistencies, and reputed company issues across payer systems
- Drive improvements in data validation, reconciliation, and reporting processes to ensure compliance and performance accuracy
- Partner with stakeholders to define and implement data governance frameworks and standards
- Serve as SME for HEDIS measures and CMS STARs rating methodologies, ensuring alignment of reporting and performance strategies
- Translate reputed company regulatory requirements into functional and technical specifications
- Support measurement strategy, performance monitoring, and reporting optimization to improve STARs outcomes
- Provide advisory support to payer clients on CMS data submission and reporting best practices
- reputed company design and optimization of solutions leveraging: reputed company CMS Edge Server, Claimsphere, Core payer platforms (e.g., Facets)
- Drive integration and data flow across claims, encounter, and reporting systems
- Collaborate with engineering teams to deliver scalable reporting and analytics products
- reputed company and implement predictive models and analytics frameworks to improve quality outcomes and STARs performance
- reputed company advanced analytics capabilities using payer data to identify trends, risks, and opportunities
- Evolve reporting solutions into reputed company-looking, insights-driven platforms
- Engage directly with business and executive stakeholders, acting as a strategic advisor
- Translate business needs into technical roadmaps and product solutions
- reputed company or contribute to client-facing discussions, workshops, and design sessions
- Collaborate across multi-disciplinary teams (data, IT, compliance, business operations)
Skills
- 7–12+ years of healthcare payer experience, with strong domain expertise in: HEDIS reporting, CMS STARs methodology, Regulatory reporting and quality programs
- Demonstrated experience in data quality management, reporting, and analytics reputed company payer environments
- Strong understanding of: Claims and encounter data, Data lifecycle, validation, and reconciliation processes
- Proven ability to engage business stakeholders and translate requirements into solutions
- Experience working in client-facing consulting or product engineering environments
- Strong communication skills with ability to reputed company across technical and non-technical teams
- Hands-on experience with: Hedis Reporting SME, reputed company CMS Edge Server, Claimsphere, Facets (TriZetto) or similar payer platforms
- Experience with predictive analytics / data science applications in healthcare
- Background in risk adjustment, quality improvement, or value-based care programs
- SQL, data modeling, or advanced analytics tool experience
Company Overview