Hedis Abstractor Jobs (NOW HIRING)

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This role is a senior level analyst responsible for powering all HEDIS improvement initiatives through advanced data analytics and insight generation. This role serves as the engine behind HEDIS strategy—owning the end-to-end analytical framework that identifies performance gaps, prioritizes opportunities, and quantifies the impact of interventions. This role requires a blend of deep Medicare/Stars HEDIS expertise, advanced analytics capability, and strong cross-functional leadership. The ideal candidate thrives in a fast-paced environment, uses data to influence decision-making, and consistently delivers measurable performance improvement.

Advanced Analytics & Modeling

• Lead the development of predictive models to identify members at risk of care gaps and prioritize outreach opportunities.
• Perform advanced statistical analyses to uncover drivers of HEDIS performance variation.
• Develop segmentation strategies (provider, population, geography) to target high-impact interventions.
• Design forecasting models to project HEDIS performance and simulate intervention scenarios.

Insight Generation & Strategic Influence

• Translate complex analytical findings into clear, actionable recommendations for executive and operational stakeholders.
• Identify the highest-value opportunities for improvement based on impact, feasibility, and ROI.
• Serve as the primary advisor on HEDIS performance trends, risks, and opportunities.

Performance Measurement & ROI Analytics

• Establish frameworks to measure the effectiveness of HEDIS interventions and initiatives.
• Conduct pre/post and longitudinal analyses to evaluate program impact.
• Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost of care implications.

Data Infrastructure & Reporting

• Design and oversee enterprise HEDIS performance dashboards and reporting tools.
• Partner with Analytics and Reporting HEDIS Technical team to ensure data quality, integration, and accessibility.
• Automate reporting and insight generation to enable real-time performance monitoring.

Cross-Functional Partnership

• Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs.
• Enable stakeholders with data, tools, and insights to execute targeted improvement initiatives.
• Present findings and recommendations to senior leadership with clarity and influence.

HEDIS Expertise & Measure Optimization

• Maintain deep expertise in HEDIS specifications, including hybrid and administrative measures.
• Identify opportunities to improve measure capture, coding accuracy, and documentation through analytics.
• Support audit readiness through data validation and performance reconciliation.

Qualifications

Required:

• 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement.
• Advanced analytical skills, including experience with predictive modeling, statistical analysis, and large datasets.
• Demonstrated ability to translate data into actionable insights that drive measurable outcomes.
• Proficiency in data tools and programming languages (e.g., SQL, Python, R).
• Experience with data visualization tools (e.g., Tableau, Power BI).

Preferred:

• Masters degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field.
• Experience with NCQA HEDIS measures and reporting processes.
• Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models.
• Experience working with claims, EHR, and supplemental data sources.