HEDIS Business Intelligence Lead

Humana

2d • Remote

About The Position

Become a part of our caring community and help us put health first The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Business Intelligence Lead plays a critical role in advancing Humana’s quality performance by leading the technical interpretation and operational application of HEDIS and Medicare Stars measure requirements. This role brings deep expertise in measure logic, coding, documentation, and data capture strategy to help ensure complex guidance is translated into practical, scalable approaches that support quality outcomes. This position will serve as a key partner in evaluating and operationalizing measure-specific opportunities across HEDIS and Stars, with a strong focus on technical research, specification interpretation, supplemental and clinical data considerations, and performance impact assessment. The Lead will help advise on complex scenarios that influence measure performance and will work across teams to support execution of changes that have material impact on ratings. The ideal candidate brings a strong blend of healthcare quality knowledge, technical curiosity, data fluency, and cross-functional collaboration. This person must be comfortable navigating ambiguity, interpreting detailed requirements, and advising on how coding, documentation, workflows, and data strategies can be aligned to improve measure performance.

Requirements

• Bachelor’s degree or equivalent experience
• 5+ years of experience in healthcare business intelligence, quality measurement, enterprise reporting and data strategy.
• Demonstrated experience interpreting complex healthcare measurement, technical, or regulatory requirements and translating them into business action
• Strong understanding of coding, documentation, data capture, and operational considerations that influence healthcare quality performance
• Experience working with healthcare data such as claims, clinical, pharmacy, provider, or supplemental data
• Strong problem-solving skills with the ability to assess ambiguity, structure issues, and recommend practical solutions
• Ability to communicate technical concepts clearly to both technical and non-technical audiences
• Experience working across multiple stakeholders in a highly matrixed environment

Nice To Haves

• Experience supporting HEDIS, Medicare Stars, or other healthcare quality programs
• Experience interpreting NCQA technical specifications, CMS guidance, or related quality measurement requirements
• Familiarity with interoperability, clinical data exchange, digital quality approaches, or emerging healthcare data capabilities
• Experience evaluating new data sources, vendor solutions, or technical capabilities for operational feasibility and business value

Responsibilities

• Lead deep technical interpretation of HEDIS and Medicare Stars measures, including measure logic, coding requirements, documentation expectations, and data capture considerations
• Advise on measure-specific strategies that align to specifications and support improved performance across quality programs
• Evaluate how supplemental, clinical, interoperability, claims, pharmacy, and provider data can support quality measurement and operational execution
• Help translate evolving CMS and NCQA guidance into actionable business recommendations and repeatable approaches
• Identify risks, gaps, and dependencies related to coding, documentation, data sourcing, and workflow design that may affect quality outcomes
• Serve as a technical advisor to leaders and partners on nuanced quality measurement questions, new opportunities, and emerging requirements
• Collaborate with business, clinical, interoperability, reporting, and operational teams to align technical measure guidance with enterprise needs
• Help strengthen enterprise understanding of measure intent, data requirements, and performance levers through clear communication and technical leadership
• Use your skills to make an impact

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level