Advisory Services Senior HEDIS Consultant - Remote

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.  

The Advisory Services Senior Consultant provides deep expertise in HEDIS data, analytics, quality measures, and CMS Medicare Stars performance, assisting organizations in ensuring compliance and improving outcomes for Medicare Advantage and other health plan populations. Responsibilities typically include data analysis, HEDIS data validation, NCQA and state specific submissions, CMS Star Ratings measure support, user acceptance testing, and developing client-facing reports and recommendations. This role requires solid analytical skills, knowledge of healthcare systems, coding (ICD, CPT), Medicare quality measurement, and experience with tools like SQL, PowerBI, and Excel.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Serve as a client-facing HEDIS consulting resource, partnering with health plan clients to understand quality reporting objectives, operational needs, and measure-specific requirements
• Analyze, validate, and interpret complex healthcare data, including claims, enrollment, provider, supplemental, and clinical data used to support HEDIS measure reporting
• Support HEDIS data validation, measure rate review, gap identification, and quality improvement analyses to help clients improve performance and meet reporting expectations
• Apply a CMS Medicare Stars lens to HEDIS measure analysis, identifying performance drivers, measure gaps, cut-point considerations, and opportunities to improve Medicare Advantage Star Ratings outcomes
• Translate HEDIS specifications, NCQA guidance, state requirements, and client business needs into actionable reporting, analytic, and operational recommendations
• Connect HEDIS results, CAHPS/HOS considerations, clinical quality outcomes, and CMS Star Ratings methodology to actionable client strategies for quality improvement and reporting readiness
• Develop and document business requirements, data mapping, validation results, issue logs, and client-facing deliverables for HEDIS reporting and audit readiness
• Use SQL, Excel, PowerBI, and related analytic tools to research data questions, assess measure logic, reconcile results, and support reporting accuracy
• Lead or support user acceptance testing, defect triage, root cause analysis, and resolution planning for HEDIS reporting processes and vendor or internal reporting platforms
• Facilitate client discussions, communicate findings clearly, and provide consultative recommendations on difficult data, reporting, and quality measurement issues
• Identify opportunities to improve HEDIS reporting workflows, data quality controls, documentation, and repeatable processes across client engagements
• Manage assigned consulting workstreams with minimal guidance, balancing priorities, timelines, client expectations, and issue resolution needs
• Coach, guide, and act as a resource for team members

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:

• 3+ years of experience with healthcare claims analysis
• 3+ years of experience; skilled in reading and writing moderate to complex SQL commands and accurately assessing results
• 3+ years of experience with analyzing HEDIS metrics or working as a Functional SME for HEDIS reporting
• Experience supporting Medicare Advantage quality performance, CMS Medicare Star Ratings measures, or Stars-related performance improvement initiatives
• Experience in a client facing role 
• Proven ability to write clearly composed documentation for business requirements, as well as information that will be distributed to auditors
• Proven ability to solve problems, including multiple priorities and researching conflicting and/or inaccurate data
• Ability to travel up to 40% of the time (Typically out on Sunday/Monday with return home on Thursday - or shorter trips - as business needs dictate)

Preferred Qualifications:

• Experience with HEDIS vendor software a plus or experience with HEDIS reporting using other tools
• Experience gathering requirements from the client/business and documenting
• Experience with process improvement, workflow, benchmarking, and/or evaluation of business processes
• SSIS ETL development experience
• Project management experience
• Working knowledge of relational databases, database structures
• Intermediate level of proficiency with PC-based software programs and automated database management systems (Excel, Access, PowerPoint)

*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.