Senior Healthcare Process & Analytics Lead (Hybrid)

Paycom; Huntington Beach (CA); Hybrid; USD 91,000 - 100,000; Full time

Job summary

Clever Care Health Plan seeks a Senior Business Process Advisor, Quality & Risk Adjustment, to bridge Risk Adjustment, Quality/Stars, Clinical Operations, and IT. You will translate CMS requirements into scalable workflows, reporting solutions, and tech enhancements to improve Medicare Advantage performance.

In this hybrid role, you will lead requirements gathering, process analysis, system testing, and performance analytics across Stars, HEDIS, CAHPS, and RAF programs, driving data-driven

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Information Systems, Data Analytics, or related field.
• Minimum five (5) years of experience in healthcare business analysis, healthcare operations, managed care, Medicare Advantage, or health plan analytics.
• Minimum three (3) years of experience supporting Medicare Stars, HEDIS, CAHPS, Risk Adjustment, Population Health, or related programs.

Responsibilities

• Lead UAT for new applications, reports, dashboards, workflows, and system enhancements.
• Develop test plans, testing scenarios, acceptance criteria, and issue logs.
• Coordinate testing activities among business stakeholders and technology partners.
• Validate data integrity, reporting outputs, and workflow functionality.
• Monitor defects and coordinate resolution activities.
• Support implementation of Salesforce, Cozeva, population health, analytics, and other operational tech solutions.

Skills

Medicare Stars

HEDIS

RAF Analytics

Power BI

SQL

UAT leadership

Data analytics

Excel

Education

Bachelor's degree

Tools

Salesforce

Tableau

Cozeva

Power BI

Job description

Clever Care Health Plan seeks a Senior Business Process Advisor, Quality & Risk Adjustment, to bridge Risk Adjustment, Quality/Stars, Clinical Operations, and IT. You will translate CMS requirements into scalable workflows, reporting solutions, and tech enhancements to improve Medicare Advantage performance.

In this hybrid role, you will lead requirements gathering, process analysis, system testing, and performance analytics across Stars, HEDIS, CAHPS, and RAF programs, driving data-driven