HEDIS ANALYST

• (2500189)
  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.

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).

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.

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.

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 #LI-JT1 #LI-REMOTE
  Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:
Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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. Our plans provide peace of mind to more than 1.2 million Ohioans.
We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
Primary Location US-Ohio
Job 7 - General Staff
Organization Clinical Quality & Health Services
Schedule Regular
Shift Standard
Employee Status Individual Contributor
Job Type Full-time
Job Level Day Job
Job Posting Aug 15, 2025, 5:23:52 P