HEDIS Business Analyst with Strong in SQL

We are seeking a Business Systems Analyst (BSA) with strong experience in HEDIS, healthcare data, and SQL to bridge business, clinical, and technical teams. The ideal candidate will analyze HEDIS requirements, translate business needs into technical specifications, and perform SQL-based data analysis and validation.

Key Responsibilities

• Gather, analyze, and document business and HEDIS requirements.
• Interpret NCQA/HEDIS measures, including numerator, denominator, exclusions, and value sets.
• Write and execute SQL queries to analyze claims, enrollment, provider, and clinical data.
• Perform data validation, reconciliation, and root-cause analysis for HEDIS results.
• Create BRDs, FRDs, user stories, process flows, and acceptance criteria.
• Work closely with HEDIS, Quality, Data Engineering, QA, and IT teams.
• Support UAT, defect analysis, and implementation of HEDIS-related solutions.
• Identify data-quality issues and recommend process/system improvements.

Required Skills

• Strong Business Analysis and requirements-gathering experience.
• Hands-on knowledge of HEDIS/NCQA healthcare quality measures.
• Strong SQL skills, including joins, CTEs, subqueries, aggregations, and window functions.
• Experience with healthcare claims, enrollment, clinical, and provider data.
• Excellent analytical, documentation, communication, and stakeholder-management skills.
• Experience with Jira/Confluence, Excel, and reporting/BI tools is preferred.