Sr. Data Analyst - HEDIS Quality Measures

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. 

Step into a high-impact Sr. Data Analyst - HEDIS Quality Measures role where data drives better health outcomes. In this position, you will serve as a key subject matter expert supporting dual Medicaid and Medicare programs, bringing deep knowledge of how these programs operate and the data that powers them. You will lead the generation and analysis of quality measure data, translating insights into actionable improvements across initiatives. Working closely with QIPD and Optum/DTMB partners, you will help coordinate efforts and establish sustainable, scalable processes that support ongoing program success. This is a dynamic, collaborative opportunity to apply your consultative expertise and make a meaningful impact on quality and performance across complex healthcare programs.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:  

• Will provide subject matter expertise related to dual Medicaid/Medicare programs, including the data generated and utilized by these programs
• Generate and analyze quality measure data and results for these projects and programs
• Work closely with QIPD staff and current Optum/DTMB staff to coordinate activities and ensure sustainable processes are in place to support the needs of these programs on an ongoing basis
• Provide consultative expertise related to the dual Medicaid/Medicare programs, including familiarity with how these programs run, and the data generated and utilized by these programs

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 5+ years of experience with Medicaid data, including the use of this data in generating quality measure results
  • Eligibility and Enrollment Data - experience and familiarity with eligibility and enrollment data to identify dual populations of interest
  • Claim Data - familiarity with Medicaid claims and encounters data; experience analyzing and understanding this data
    • Medical claims and encounters
    • Dental claims and encounters 
    • LTSS claims and encounters
• 5+ years of experience and familiarity with Medicare data, including the use of this data in generating quality measure results for the dual Medicaid/Medicare population
  • Eligibility and Enrollment Data - experience and familiarity with eligibility and enrollment data to identify dual populations of interest
  • Claim Data - familiarity with Medicare claims and encounters data; experience analyzing and understanding this data
    • Medical claims and encounters
    • Pharmacy claims and encounters
• 5+ years of experience using SQL
• 5+ years of experience working with technical developers, end users/customers to strategize solutions to align with business requirements
• 3+ years of experience in Generation of Quality Measures - familiarity with quality measure specifications, including Medicare-specific measures utilized by dual populations
  • Ideal candidate would have experience in custom-coding quality measures, as well as utilizing commercial products to generate results
• 3+ years of experience facilitating business requirements gathering, technical documentation, test plan creation
• 3+ years of experience with all phases of SDLC

Preferred Qualifications:

• Experience and knowledge of the State of Michigan's licensed commercial product, Symmetry EBM
• Experience facilitating customer requirements gathering meetings/sessions/JAD Sessions, and analytical business value.
• Ability to recognize, gather, correlate, and analyze facts, draw conclusions, define problems, and devise solutions and alternatives and make appropriate recommendations.
• Business Analyst experience in a state government environment

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.