About this role.
This is a remote Analyst role focused on health plan risk and quality reporting for a managed care organization. The position involves building custom reports, tracking HEDIS performance, conducting root-cause analysis, and collaborating with national teams. Candidates need at least 2 years of data analysis experience with HEDIS or risk adjustment, plus proficiency in SQL, Power BI, and Databricks. The role requires strong analytical skills and the ability to manage multiple priorities in a fast-paced environment.
Role DNA
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Job Complexity
3/5Pace & Pressure
4/5Autonomy Level
3/5Communication Load
4/5Salary analysis
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Core skills
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Cover letter sample
Dear Hiring Manager,
I am excited to apply for the Analyst, Health Plan Risk & Quality Reporting position. With over two years of experience in data analysis within managed care, I have a strong background in HEDIS and risk adjustment reporting. My proficiency in SQL, Power BI, and Databricks allows me to build custom reports and derive actionable insights for quality improvement.
In my previous role, I successfully developed intervention tracking reports that improved gap closure rates by 15%. I am adept at root-cause analysis and collaborating with cross-functional teams to drive performance. I am confident that my analytical skills and healthcare domain knowledge make me a strong fit for this role.
Thank you for considering my application. I look forward to the opportunity to discuss how I can contribute to your team.
Sincerely,
[Your Name]
Sample interview questions
In my previous role, I worked extensively with HEDIS measures for Medicaid and Medicare lines of business. I developed SQL queries to pull claims and lab data, then created Power BI dashboards to track performance gaps. For example, I identified a trend in low colorectal cancer screening rates and collaborated with the outreach team to target members, resulting in a 10% improvement.
I prioritize by assessing urgency and impact, using agile methodologies to break down tasks. For instance, when juggling a regulatory report and an ad hoc request, I communicate with stakeholders to set expectations and ensure the most critical items are delivered first. I also use project management tools like Jira to track progress.
I once wrote a query to calculate HEDIS rates from raw claims data. It involved multiple CTEs to join medical claims, pharmacy claims, and enrollment tables, applying date filters and exclusion criteria. I used window functions to deduplicate and then aggregated by member to compute compliance. The query was optimized to run in less than 2 minutes on millions of rows.
I implement validation checks at each step: verify source data completeness, cross-check totals against warehouse reports, and use reconciliation queries. I also document assumptions and test edge cases. For example, I compare my calculated HEDIS rates against the official NCQA outputs to ensure alignment before sharing.
We had a discrepancy in risk adjustment scores between our system and the vendor's. I traced the data flow from the EHR to claims, and found that a mapping error in the diagnosis code translation was dropping certain conditions. I worked with the IT team to fix the mapping, and then reran the scores, which corrected the discrepancy.
JOB DESCRIPTION Job Summary
Provides analyst support for health plan risk and quality reporting activities. Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of initiatives. Educates users on how to use reports related to risk and quality/Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid, Medicare, Marketplace and Medicare/Medicare-Medicaid Plan (MMP). Assists with research, development, and completion of special quality performance improvement projects including root-cause analysis.
Essential Job Duties
• Captures and documents health plan quality reporting requirements, builds custom reports, and educates health plan users on how to use reports.
• Builds intervention strategy reporting for the risk and quality interventions and measures gap closure.
• Builds ad hoc quality reports as requested to track HEDIS performance and supplemental data monitoring.
• Develops quality assurance (QA) custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Develops custom health plan reports related to managed care data including medical claims, pharmacy, lab and HEDIS rates.
• Collaborates with the national risk and quality team on testing of pre-production reporting for assigned health plan.
• Calculates and tracks gap closure and intervention outcome reporting for the assigned health plan.
• Works in an agile business environment to derive meaningful information out of complex and large organizational data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks Structured Query Language (SQL), PowerBi, Microsoft Excel, and techniques to determine significance and relevance.
• Assists with research, development and completion of special quality-related projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
• Represents as a key partner to assist with testing changes in the Datawarehouse platform and performs transparent upgrades to reporting modules to ensure no impact to the end users.
• Conducts preliminary and post-impact analyses for any logic and source code changes for data and reporting module – keeping other variables as constant that are not of focus.
• Represents as a HEDIS subject matter expert, and supports health plan improve performance on underperforming quality measures.
Required Qualifications
• At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment, and 1 year of experience in a managed care organization, or equivalent combination of relevant education and experience.
• Analytical mindset with excellent attention to detail.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong business acumen with the ability to connect data insights to strategic goals.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.
• Microsoft Office suite (including advanced Excel), and applicable software programs proficiency.
Preferred Qualifications
• Certified Professional in Healthcare Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse. If licensed, license must be active and unrestricted in state of practice.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Annual salary information is not provided for this position. Explore salary ranges for similar roles in our Salary Directory ›
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