Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
About the Role
The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out quality analytics. The incumbent for this position will design and implement a structured approach to data quality, ensuring our HEDIS data accurately reflects the health status of our members. The position is a key team member collaborating in a multi-disciplinary business environment with colleagues across the enterprise to lead quality performance analytics, development, and reporting that deliver actionable insights. As a subject matter expert, the role collects business requirements as per State, CMS, and NCQA specifications, translates business requirements into analytics design, define data &amp; analytics specifications, manipulates and analyze large healthcare data from various data sources, and interpret the findings to inform opportunities and solutions that improve clinical quality and increase cost efficiency and health care affordability. This position requires advanced data analytic programming and coding skills with robust knowledge and understanding of the healthcare business and data.
What You'll Do
<ul>
<li>Functions as the implementation lead for projects designed to improve HEDIS, Stars, accreditation and State performance.</li>
<li>Functions as the vendor relationship owner (VRO) to vendors utilized intended to improve quality performance.</li>
<li>Builds robust quality assurance criteria and processes to ensure regulatory reporting data is complete and accurate.</li>
<li>Acts as the analytic liaison for complex clinical analytics projects involving multiple data resources and teams to inform business decisions in clinical, network, and value-based performance models.</li>
<li>Understands the strategic direction of the organization and the analytic and reporting requirements to meet departmental needs. Translates business questions and needs into analytics technical requirements including data analytics design, clinical and data.</li>
<li>Creates integrated analytic datasets and summarizes findings to inform business opportunities and address business questions. Provides insight and guidance into analytic findings (including root causes and contributing factors – both actionable and not) through clear, professional, succinct written and oral summaries, tables, charts, reports, or presentations.</li>
<li>Navigates across multiple analytical and business units to socialize analytics design, results and interpretation, including making recommendations on how to use the results to inform business decisions.</li>
<li>Documents methods, specifications and findings clearly. Collaborate with team members to document work appropriately, including SAS coding comments and use of analytic plan/timeline where needed for analytic projects.</li>
<li>Presents analytics findings to internal leadership teams to inform actionable opportunities and solutions.</li>
<li>Provides technical trainings (analytics design, data, programming, QA, statistics, documentation, etc.) to junior analysts.</li>
</ul>
What You Bring
Education/Experience:
<ul>
<li>High School Diploma/GED required.</li>
<li>Bachelor degree in Math, Statistics, Data Science, or Public Health preferred or relevant experience in lieu of degree.</li>
<li>Requires a minimum of 5 years of experience in data analytics, HEDIS, SAS or related field.</li>
<li>Requires a minimum of 5 years of experience performing analysis on healthcare data, HEDIS data or relational health care databases with significant experience analyzing medical, pharmacy and behavioral data.</li>
</ul>
Knowledge:
<ul>
<li>Requires extensive knowledge of US healthcare industry, health plan business, claims data, clinical data, and coding practices.</li>
<li>Prefers knowledge and working experience of visualization and BI tools (e.g., Tableau) with preference given to Tableau experience.</li>
</ul>
Skills and Abilities:
<ul>
<li>Strongly Prefers SAS, SQL and Python experience</li>
<li>Requires proficiency with MS Excel for data analysis and reporting.</li>
<li>Requires solid organizational skills and attention to details.</li>
<li>Requires strong ability to work in a fast-paced team-oriented environment and strong ability to manage competing priorities.</li>
<li>Must be highly motivated and able to work independently.</li>
</ul>
Why Horizon?
At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!
Salary Range:
$109,600 - $149,625
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
<ul>
<li>Comprehensive health benefits (Medical/Dental/Vision)</li>
<li>Retirement Plans</li>
<li>Generous PTO</li>
<li>Incentive Plans</li>
<li>Wellness Programs</li>
<li>Paid Volunteer Time Off</li>
<li>Tuition Reimbursement</li>
</ul>
Disclaimer:
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

HEDIS Data Quality Integrity Analyst

HEDIS Data Quality Integrity Analyst

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