About the job
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Supports corporate and departmental strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members’ health outcomes.
Note: This is a fully remote opportunity. Eastern Time Zones preferred.
Responsibilities
- HEDIS Analyst II
- Supports annual HEDIS roadmap through data documentation, reconciliation, and auditor collaboration.
- Ensures data accuracy per HEDIS specifications.
- Assists with data loading and chart collection.
- Produces reports to support clinical quality initiatives.
- May train junior analysts.
HEDIS Analyst III
- Provides advanced analytical support for quality improvement initiatives.
- Develops customized trend reports and collaborates across departments.
- Participates in HEDIS submission processes.
- Mentors junior analysts.
Senior HEDIS Analyst
- Leads complex analytics and reporting to inform strategic decisions.
- Oversees mapping documentation and HEDIS specification implementation.
- Mentors and may supervise junior analysts.
- Coordinates with internal teams and vendors to ensure data integrity.
Lead HEDIS Analyst
- Manages project prioritization, team oversight, and strategic planning.
- Leads development of analytic tools and reporting deliverables.
- Serves as subject matter expert and presents insights to stakeholders.
- Guides continuous improvement and builds collaborative relationships.
Qualifications – External
HEDIS Analyst II
Education And Experience:
- Bachelors Degree in health care administration, public health, or a related field.
- 2 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience.
Technical Skills And Knowledge:
- Knowledge of health insurance industry.
- Knowledge of project management.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Intermediate proficiency in database reporting (SQL) and analytics programming languages (SAS).
HEDIS Analyst III
Education And Experience
- Bachelors Degree in health care administration, public health, or related field.
- 3 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience. programs
Technical Skills And Knowledge:
- Ability to identify opportunities and propose solutions.
- Ability to develop and produce complex reports and dashboards.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Advanced knowledge of health insurance industry and health plan operations.
- Ability to utilize certified HEDIS software.
- Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
- Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.
- Advanced proficiency in database reporting (SQL) and analytics programming languages (SAS) and data visualization tools such as Tableau.
Sr HEDIS Analyst
Education And Experience:
- Bachelors Degree in health care administration, public health, or related field
- Master’s degree (MBA, MPH, or MHA) preferred
- 5 years progressive experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience
Technical Skills And Knowledge:
- Ability in identify opportunities and propose solutions.
- Ability to develop and produce complex reports and dashboards.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Advanced knowledge of health insurance industry and health plan operations.
- Advanced proficiency in database reporting and data visualization tools including SQL, SAS, and Tableau.
- Ability to utilize certified HEDIS software.
- Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
- Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.
Lead HEDIS Analyst
Education And Experience:
- Bachelor’s degree in healthcare administration, business administration, information technology or a related field .
- Master’s degree (MBA, MPH, or MHA) preferred.
- 7 years progressive experience as a Clinical Quality Data Analyst or equivalent experience conducting analyses and delivering analytic results in a health care, health insurance, consulting, or delivery organization.
- HEDIS experience preferred.
Technical Skills And Knowledge:
- Advanced knowledge of health plan operations, data sources, and data structures, including trends and drivers of quality. Solid understanding of claim submissions and database management.
- Advanced knowledge of Extract, Transform, and Load (ETL) data processes.
- Advanced knowledge of HEDIS, NCQA and CMS Stars quality metrics and the ability to apply concepts to business operations.
- Advanced knowledge of health plan data sources.
- Advanced skills in database reporting and expertise in data extraction and analytical programming languages (SAS, SQL), and data visualization tools (Tableau).
- Strong project management skills.
- Demonstrated ability to draft analytical assessments and summarize content to non-technical audience.
- Ability in identify opportunities and propose solutions.
- Ability to develop and produce complex reports and dashboards.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality