HEDIS Analyst/Consultant

E-Solutions, Inc.; United States; Remote; USD 90,000 - 140,000; Full time

Job summary

E-Solutions, Inc. is seeking a skilled HEDIS Analyst/Consultant for a remote role serving US healthcare payers.

The ideal candidate will combine actuarial, underwriting, and quality analytics to improve HEDIS outcomes and data quality. You will work with SQL, data profiling, data lineage, and mapping across claims, enrollment, provider, and premium data, with Snowflake experience preferred to support analytics modernization.

Qualifications

• Strong knowledge of US healthcare payer domain and analytics.
• Hands-on experience with actuarial concepts, underwriting, HEDIS/Quality.
• Proficiency in SQL, data profiling, and data mapping.
• Experience with healthcare data (claims, enrollment, provider, premium).

Skills

US Healthcare Payer

Actuarial

Underwriting

HEDIS Quality

Claims Data

PMPM/MLR/IBNR

SQL Profiling

Data Lineage

Data Mapping

Rule Discovery

Reverse Engineering

Healthcare Analytics

Data Modernization

Tools

Snowflake

Job description

Hi Professionals,

Title: HEDIS Analyst/Consultant

Locattion: Remote

JD:

Must-Have:

• US Healthcare Payer
• Actuarial
• Underwriting
• HEDIS / Quality
• Claims & Enrollment Data
• PMPM / MLR / IBNR / Risk Adjustment
• SQL & Data Profiling
• Data Lineage / Data Mapping
• Business Rule Discovery
• Reverse Engineering
• Healthcare Analytics / Data Modernization
• Snowflake (Preferred)

Key Requirements:

• Strong US Healthcare Payer domain expertise
• Experience with Actuarial, Underwriting & HEDIS/Quality
• Knowledge of payer metrics: PMPM, MLR, IBNR, Risk Adjustment, Cost & Utilization
• Hands-on experience with Claims, Membership, Provider, Premium & Clinical data
• Strong SQL, Data Analysis & Data Profiling skills
• Ability to reverse engineer business rules, data flows, lineage & mappings
• Bridge communication between business SMEs and technical teams
• Healthcare analytics, transformation, or data modernization experience preferred
• Exposure to Snowflake, Semantic Modeling, Metadata Management, AI-enabled Analytics is a plus

HEDIS Analyst/Consultant1HEDIS Analyst/Consultant,US Healthcare Payer Actuarial Underwriting HEDIS / Quality Claims & Enrollment Data PMPM / MLR / IBNR / Risk Adjustment SQL & Data Profiling Data Lineage / Data Mapping Business Rule Discovery Reverse Engineering Healthcare Analytics / Data ModernizaN/AC2CUnited States