Quality Analytics Analyst III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Quality Analytics Healthcare Analyst is responsible for delivering analytics and insights that support Medica’s Quality Strategy, including performance across STARS, HEDIS, NCQA, and regulatory quality programs. This role translates healthcare, clinical, and claims data into actionable insights that drive improvements in quality outcomes, member experience, provider performance, and financial results. Performs other duties as assigned.

• Develop, maintain, and enhance analytics and reporting supporting:
  oSTARS performance
  oHEDIS measures
  oProvider quality outcomes
  o Member engagement and care management effectiveness
• Translate complex healthcare data into actionable insights that support quality improvement and business decision-making
• Ensure outputs are accurate, timely, and aligned with business and regulatory requirements

• Collaborate with Quality, Clinical, Actuarial, Finance, Network, and Operations teams to align analytics to business outcomes
• Serve as an analytic consultant by explaining:
  oResults
  oMethodology
  oAssumptions
  o Implications for quality performance
• Support enterprise initiatives tied to Healthcare Value (HCV), affordability, and quality integration

• Ensure integrity and reliability of quality data through:
  oValidation processes
  oData quality checks
  o Peer reviews
• Identify data issues, perform root-cause analysis, and recommend corrective actions
• Contribute to data governance and stewardship practices across the team

• Monitor key quality KPIs (e.g., STARS ratings, HEDIS rates, gap closure)
• Identify trends, variances, and emerging risks or opportunities
• Proactively communicate insights and actionable recommendations to stakeholders.

• Design dashboards and visualizations using tools such as Power BI or Tableau
• Tailor communication to audiences ranging from technical teams to executive leadership
• Apply storytelling techniques to clearly articulate insights and business impact

• Maintain working knowledge of:
  oSTARS and HEDIS methodologies
  oNCQA standards
  o CMS quality programs
• Ensure analytics and reporting align to evolving regulatory requirements

• Conduct benchmarking and comparative analysis using:
  oIndustry standards
  oInternal historical performance
  o Peer comparisons
• Identify opportunities for improvement and inform quality strategy

• Identify opportunities to improve:
  oAnalytic efficiency
  oReporting automation
  o Data usability
• Contribute to standardization, documentation, and best practices
• Support adoption of new tools, including automation and AI-enabled analytics

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience beyond degree

• Technical Skills
  • SQL and data analysis tools (R, Python, SAS, etc.)
  • Data visualization tools (Power BI, Tableau)
  • Experience with healthcare data (claims,…