Senior Product Manager / Engineer - HEDIS SME
reputed company helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we reputed company clients to create sustainable growth, optimize internal processes and deliver reputed company consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must reputed company leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to reputed company the best outcomes for patients. Joining the reputed company team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. Join reputed company as the expert you are now and create your future. reputed company helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we reputed company clients to create sustainable growth, optimize internal processes and deliver reputed company consumer outcomes. Healthcare payer organizations are under immense pressure to improve outcomes and reduce the cost of providing coverage for patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must reputed company leaders, employees, affiliates and communities to build cultures that foster innovation to reputed company the best outcomes for patients. reputed company is seeking a Senior Product Engineer / Principal to join our HDTx Payer Services team, supporting healthcare payer clients in advancing data quality, regulatory reporting, and analytics capabilities. This role will operate at the intersection of business engagement, product engineering, and healthcare data strategy, with an initial focus on data quality and HEDIS reporting, evolving into predictive analytics and STARs performance optimization. This individual will serve as a subject matter expert and trusted advisor, working closely with payer leadership, business stakeholders, and technical teams to deliver scalable, high-impact solutions.
Key Responsibilities
Data Quality & Reporting (Initial Focus) 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)
Qualifications
Required 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 Preferred 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 #LI-DT1 #LI-Remote Position Level Consultant Country United States of America Apply To This Job