Analista de Processos avaliando e revisando processos da empresa com foco na eficiência e segurança. Implementação de controles internos e melhorias contínuas em colaboração com várias áreas.
About the role
- Senior Quality Analyst responsible for performance analysis in SCAN's Medicare Advantage STAR Program. Collaborating cross-functionally to improve clinical quality, customer experience, and operational compliance.
Responsibilities
- Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures
- Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions
- Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners
- Model future projections and perform “What-if” scenarios for STAR rating forecasts
- Conduct routine process analysis for department’s operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks
- Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies
- Track performance of interventions and provide data-driven insights on progress and effectiveness
- Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities
- Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies
- Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes
- Actively support the achievement of SCAN’s Vision and Goals
Requirements
- Experience as a Senior Quality Analyst within a health plan or healthcare organization working with a STAR program is highly desirable
- Bachelor's Degree or equivalent experience required
- Master’s degree in a related field preferred
- Experience working within a health plan STAR team
- Familiarity with claims, encounter, and EMR data
- Experience supporting provider engagement or quality improvement initiatives
- Strong knowledge of CMS STAR Ratings methodology, HEDIS measures, CAHPS, HOS, and Medicare Advantage quality programs
- Advanced proficiency in data analysis tools (Excel, SQL, Python, SAS, R, Tableau, or Power BI)
- Proficient with MS Office (Access, Word, Excel, PowerPoint) and e-mail
- Ability to communicate complex analytical information to diverse audiences
- Analytical Thinking and Problem-Solving - excel in breaking down complex information and deriving actionable insights
- Strong organizational and project management skills
- Ability to work independently and in a team environment
- Strong team player
- Ability to work under tight deadlines & manage multiple responsibilities independently
Benefits
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
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