About UHG

Careers at UnitedHealth Group


We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Business Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Hedis/Stars Data Subject Matter Expert - Telecommute

UHG - Eden Prairie, Minnesota

Posted: 11/12/2018

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:

  • Have experience and expertise in SQL
  • Be able to read, and write SQL code with knowledge of inner and outer joins, table and view properties, and ability to review and understand a data dictionary as it relates to a database environment
  • Understand HEDIS data
  • Have expertise in health plan data; Member, Enrollment, Provider, Lab, Visits, Pharmacy, etc
  • Understand Supplemental data concepts for HEDIS
  • Understand basic concepts of CMS Quality Rating System
  • Experience working in a matrix environment
  • Develop data driven metrics to identify gaps and implement interventions to improve results on key performance measures
  • Thorough understanding of measure analytics to perform investigative research
  • Evaluates and prioritizes recommendations for quality improvement to customers.
  • Familiarity with ICD - 9 - CM, ICD - 10 - CM , CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
  • Be able to translate data from various formats and data warehouses
  • Be able to merge and append data from various sources
  • Experience in Data Validation
  • Provide guidance to clients on data issues and data questions
  • Knowledge of claims and claims processing
  • Demonstrates ability to consistently follow published HEDIS and Stars technical specifications
  • Provide strategic support in preparation of the HEDIS Roadmap, HOQ, HEDIS audit
  • Be able to present to clients data results via webex
  • Intermediate to expert level in MS Office, especially MS Excel for data validation reports and summary rate report compilation of results / edits required, etc

Required Qualifications:

  • Bachelor's Degree
  • 5+ years of experience in a health care delivery organization, such as a managed care organization
  • 5+ years of HEDIS experience, performing a wide range of functions with strong focus on data analysis
  • 5+ years of data analysis experience
  • 5+ years working with final submission files to NCQA, CMS, California P4P, NY QARR, and / or other state submissions
  • 3+ years of writing SQL code
  • Intermediate knowledge of Excel
  • Knowledge of Medicaid and / or Medicare programs
  • Knowledgeable of current trends in HEDIS in managed health care
  • Understand basic concepts of CMS Quality Rating System
  • 1+ years of experience working in a matrix environment

Preferred Qualifications:

  • STARS experience
  • Knowledge of NCQA, CMS, HOS, and CAHPS requirements
  • Familiarity with ICD - 9 - CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

Careers with Optum. We built an entire organization around one giant objective; make the health system work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on an elite team. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: analysis, data analysis, business analysis consultant, senior business analysis, senior data analysis, business requirements, Eden Prairie, Minneapolis, Minnesota, MN, Telecommuter, Telecommuting, Telecommute, HEDIS, CMS, data analysis, reporting, NCQA, Medicare, STARS, SQL, medical coding

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