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Hedis Data Analyst Jobs (NOW HIRING)

Astiva Health

Healthcare Data Analyst

Orange, CA

$85K - $115K/yr

This role focuses on key areas including risk adjustment, quality measures (HEDIS and Star Ratings ... Data Analysis & Reporting * Analyze medical and pharmacy claims, membership, supplement, lab, risk ...

SA Technologies Inc.

Sr.Data Analyst

Pasadena, CA · On-site

$93K - $118K/yr

Data Analyst position helps analyze business information and reporting needs. Access existing data ... Broad familiarity with Hedis. Must be an independent self-starter. Desired Skills: Minimum 4 years ...

VIVA USA INC

Quality Audit Specialist

Chicago, IL · On-site +1

... HEDIS reporting, technical data analysis in formal audit formal audit environment. Understanding of NCQA HEDIS quality measures and related code value sets. Experience in HEDIS value sets and codes ...

Comtech, LLC

Senior Data Analyst/Modeler

Washington, DC · On-site

$97K - $122K/yr

Data Analysis is the art of collecting and analyzing data so that can be use said data to address ... HEDIS, Fraud, Waste & Abuse Working knowledge of ETL Working knowledge of ALM Additional ...

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How much do hedis data analyst jobs pay per year?

As of Aug 6, 2026, the average yearly pay for hedis data analyst in the United States is $82,640.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,500.00 and $97,000.00 per year, depending on experience, location, and employer.

What are common challenges faced by HEDIS Data Analysts, and how can they be addressed?

HEDIS Data Analysts often encounter challenges such as managing large volumes of complex healthcare data, ensuring data accuracy, and meeting tight reporting deadlines set by regulatory agencies. To address these, it's important to use efficient data validation techniques and collaborate closely with clinical teams to clarify documentation or address data gaps. Staying current with evolving HEDIS measure specifications and best practices also helps overcome changes in reporting requirements. Supportive team environments, ongoing training, and robust analytical tools are often available to help analysts succeed. By proactively seeking solutions and collaborating across departments, HEDIS Data Analysts play a key role in the success of quality improvement programs.

What are the key skills and qualifications needed to thrive as a HEDIS Data Analyst?

To thrive as a HEDIS Data Analyst, you need strong analytical skills, detailed knowledge of HEDIS measures, and typically a degree in health informatics, statistics, or a related field. Familiarity with data analysis tools like SQL, SAS, or Python, as well as experience with healthcare data systems and possibly NCQA HEDIS certifications, is essential. Strong attention to detail, problem-solving abilities, and effective communication skills help analysts interpret results and collaborate with other healthcare professionals. These skills are vital to ensure accurate data reporting, facilitate quality improvement initiatives, and support health plan compliance requirements.

What is a HEDIS Data Analyst?

A HEDIS Data Analyst is responsible for collecting, analyzing, and reporting healthcare quality data based on the Healthcare Effectiveness Data and Information Set (HEDIS) measures. They work with large datasets to evaluate healthcare provider performance, ensure compliance with regulatory standards, and identify areas for quality improvement. Their role involves data validation, reporting, and collaborating with healthcare teams to enhance patient care outcomes. Strong analytical skills, proficiency in data management tools, and knowledge of healthcare regulations are essential for this role.

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Hedis Data Analyst jobs near you
Infographic showing various Hedis Data Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 12% Part Time, and 4% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $82,640 per year, or $39.7 per hour.

Healthcare Data Analyst

Astiva Health

Orange, CA

$85K - $115K/yr

Other

Re-posted 19 days ago

Job description

Description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.


SUMMARY:

The Healthcare Data Analyst is responsible for analyzing healthcare data to support clinical, operational, and financial decision-making within Medicare Advantage programs. This role focuses on key areas including risk adjustment, quality measures (HEDIS and Star Ratings), pharmacy adherence, and claims analysis. 

The analyst collaborates with clinical, quality, pharmacy, and provider teams to identify trends, monitor program performance, and support CMS regulatory reporting. The role also includes developing automated data workflows and reporting solutions that deliver timely, actionable insights across the organization.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:


Data Analysis & Reporting

  • Analyze medical and pharmacy claims, membership, supplement, lab, risk adjustment, and encounter data to support Medicare Advantage quality, risk, and operational programs.
  • Develop and maintain dashboards and reports for HEDIS, Star Ratings, medication adherence, RAF/HCC performance, and EDPS encounter data.
  • Identify trends, care gaps, and performance opportunities to support quality improvement, pharmacy initiatives, and risk adjustment efforts.
  • Provide analytics and reporting to MSOs/IPAs and internal teams, including quality, pharmacy, and risk adjustment.
  • Support regulatory and CMS-related analyses, including encounter data monitoring, claims acceptance, and HCC performance.
  • Deliver consolidated reporting and insights to leadership for strategic decision-making.
  • Examine payments, cost of care, and utilization data to produce metrics for bid submission and JOMs or to address concerns from business partners.
  • Support ad hoc reporting needs across the organization.

Data Quality & Validation

  • Validate and reconcile claims, pharmacy, provider, membership, supplement, and lab data to ensure accuracy and completeness.
  • Investigate and resolve data discrepancies, anomalies, and reporting issues across Medicare Advantage data sources.

Technical & Database Work

  • Write and optimize SQL queries and stored procedures for data extraction, transformation, and analysis.
  • Develop automated ETL workflows and data pipelines to support ongoing reporting needs.
  • Work with large datasets in SQL Server and healthcare analytics platforms.
  • Build dashboards and data visualizations using Power BI or SSRS.
  • Utilize tools such as SQL Server, SSIS, Power BI, SSRS, Python, and Excel.

Collaboration

  • Partner with clinical, pharmacy, quality, enrollment, credentialing, and finance teams to interpret results and support program initiatives.
  • Assist with regulatory and compliance-related reporting requirements.
  • Present findings and insights to both technical and non-technical stakeholders

Requirements

Required Qualifications

  • Bachelor's degree in Data Analytics, Health Informatics, Statistics, Computer Science, or related field.
  • 2-5+ years of healthcare data analytics experience.
  • Knowledge of Medicare Advantage programs, HEDIS, and/or CMS Star Ratings.
  • Advanced SQL skills for querying and analyzing large datasets.
  • Experience with BI tools such as Power BI, SSRS, or similar tools.
  • Strong analytical, problem-solving, and communication skills.

Preferred Qualifications

  • Experience working in Medicare Advantage organizations, MSOs, or managed care settings.
  • Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements.
  • Experience analyzing pharmacy adherence metrics (e.g., PDC).
  • Familiarity with EDPS encounter data, claims submissions, and acceptance processes.
  • Experience with ETL tools (e.g., SSIS) or programming languages such as Python or .NET.

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