Business Intelligence Lead - Hedis Preventive

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 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.

Location: remote

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.
In this pivotal role, you will provide analytical expertise and strategic insights that drive our Stars program success. Your work will directly support leadership decision-making and the advancement of Stars improvement efforts. This is an exciting opportunity for a seasoned professional to influence outcomes that improve member health, enhance plan quality and drive organizational growth.

Key Responsibilities:

Strategic Analysis:

• Analyze the impact of member growth, retention and movement on Star Ratings working with claims, clinical and quality data.

• Develop insights that inform business strategies and operational improvements to support Star Rating goals

• Interpret complex data to evaluate program nuances and their implications on performance

Leadership Support:

• Prepare high-quality, data-driven materials for VP and senior leadership discussions

• Participate in strategic conversations, providing actionable insights and recommendations

• Communicate complex analytical findings in a clear and compelling manner to non-technical audiences

Stars Improvement Initiatives:

• Collaborate with cross-functional teams to assess and enhance Stars performance

• Act as a subject matter expert, explaining the intricacies of Stars methodology and metrics

Data Visualization and Reporting:

• Create executive-level dashboards and presentations that showcase key metrics, trends and improvement opportunities

• Ensure data accuracy, consistency and clarity in all reporting and analysis

Use your skills to make an impact
 

Role Essentials

• Bachelor's degree

• 7 or more years of technical experience in data analysis

• 3+ years of experience in Medicare Advantage, Stars programs or healthcare analytics

• Strong understanding of CMS Star Ratings and Medicare Advantage programs

• Experience with tools such as Tableau, SQL, Power BI and/or QlikView

• Advanced experience working with big and complex data sets within large organizations

• Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction

• Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs

• Excellent communication and presentation skills, with the ability to convey complex concepts clearly to senior leadership

Role Desirables

• Experience with payer claims data

• Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field

• Advanced in SQL, SAS and other data systems

• Experience with tools such as Tableau and Qlik for creating data visualizations

• Expertise in data mining, forecasting, simulation, and/or predictive modeling

• Experience creating analytics solutions for various healthcare sectors

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$117,600 - $161,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of 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.

Application Deadline: 06-15-2026
About us
 About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.