HEDIS Business Intelligence Lead

Become a part of our caring community and help us put health first
 

The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Business Intelligence Lead plays a critical role in advancing Humana’s quality performance by leading the technical interpretation and operational application of HEDIS and Medicare Stars measure requirements. This role brings deep expertise in measure logic, coding, documentation, and data capture strategy to help ensure complex guidance is translated into practical, scalable approaches that support quality outcomes.

This position will serve as a key partner in evaluating and operationalizing measure-specific opportunities across HEDIS and Stars, with a strong focus on technical research, specification interpretation, supplemental and clinical data considerations, and performance impact assessment. The Lead will help advise on complex scenarios that influence measure performance and will work across teams to support execution of changes that have material impact on ratings.

The ideal candidate brings a strong blend of healthcare quality knowledge, technical curiosity, data fluency, and cross-functional collaboration. This person must be comfortable navigating ambiguity, interpreting detailed requirements, and advising on how coding, documentation, workflows, and data strategies can be aligned to improve measure performance.

Key Responsibilities

• Lead deep technical interpretation of HEDIS and Medicare Stars measures, including measure logic, coding requirements, documentation expectations, and data capture considerations
• Advise on measure-specific strategies that align to specifications and support improved performance across quality programs
•  Evaluate how supplemental, clinical, interoperability, claims, pharmacy, and provider data can support quality measurement and operational execution
•  Help translate evolving CMS and NCQA guidance into actionable business recommendations and repeatable approaches
• Identify risks, gaps, and dependencies related to coding, documentation, data sourcing, and workflow design that may affect quality outcomes
• Serve as a technical advisor to leaders and partners on nuanced quality measurement questions, new opportunities, and emerging requirements
• Collaborate with business, clinical, interoperability, reporting, and operational teams to align technical measure guidance with enterprise needs
• Help strengthen enterprise understanding of measure intent, data requirements, and performance levers through clear communication and technical leadership

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree or equivalent experience
• 5+ years of experience in healthcare business intelligence, quality measurement, enterprise reporting and data strategy.
• Demonstrated experience interpreting complex healthcare measurement, technical, or regulatory requirements and translating them into business action
• Strong understanding of coding, documentation, data capture, and operational considerations that influence healthcare quality performance
•  Experience working with healthcare data such as claims, clinical, pharmacy, provider, or supplemental data
•  Strong problem-solving skills with the ability to assess ambiguity, structure issues, and recommend practical solutions
• Ability to communicate technical concepts clearly to both technical and non-technical audiences
• Experience working across multiple stakeholders in a highly matrixed environment
   

Preferred Qualifications

• Experience supporting HEDIS, Medicare Stars, or other healthcare quality programs
• Experience interpreting NCQA technical specifications, CMS guidance, or related quality measurement requirements
• Familiarity with interoperability, clinical data exchange, digital quality approaches, or emerging healthcare data capabilities
• Experience evaluating new data sources, vendor solutions, or technical capabilities for operational feasibility and business value

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Although this position is remote, residency close to or within Louisville KY preferred for occasional travel to Humana offices for meetings.

 

This role is not eligible for work visa sponsorship.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$117,600 - $161,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 03-22-2026

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.