Senior Product Manager / Engineer - HEDIS SME

Key Responsibilities Data Quality & Reporting (Initial Focus) Lead data quality initiatives impacting HEDIS, CMS submissions, and regulatory reporting accuracy Assess, identify, and resolve data gaps, inconsistencies, and lineage issues across payer systems Drive improvements in data validation, reconciliation, and reporting processes to ensure compliance and performance accuracy Partner with stakeholders to define and implement data governance frameworks and standards Serve as SME for HEDIS measures and CMS STARs rating methodologies, ensuring alignment of reporting and performance strategies Translate complex regulatory requirements into functional and technical specifications Support measurement strategy, performance monitoring, and reporting optimization to improve STARs outcomes Provide advisory support to payer clients on CMS data submission and reporting best practices Lead design and optimization of solutions leveraging: Cognizant CMS Edge Server Claimsphere Core payer platforms (e.g., Facets) Drive integration and data flow across claims, encounter, and reporting systems Collaborate with engineering teams to deliver scalable reporting and analytics products Develop and implement predictive models and analytics frameworks to improve quality outcomes and STARs performance Enable advanced analytics capabilities using payer data to identify trends, risks, and opportunities Evolve reporting solutions into forward-looking, insights-driven platforms Engage directly with business and executive stakeholders, acting as a strategic advisor Translate business needs into technical roadmaps and product solutions Lead or contribute to client-facing discussions, workshops, and design sessions Collaborate across multi-disciplinary teams (data, IT, compliance, business operations)

Qualifications Required 7-12+ years of healthcare payer experience, with strong domain expertise in: HEDIS reporting CMS STARs methodology Regulatory reporting and quality programs Demonstrated experience in data quality management, reporting, and analytics within payer environments Strong understanding of: Claims and encounter data Data lifecycle, validation, and reconciliation processes Proven ability to engage business stakeholders and translate requirements into solutions Experience working in client-facing consulting or product engineering environments Strong communication skills with ability to interface across technical and non-technical teams Preferred Hands-on experience with: Hedis Reporting SME Cognizant CMS Edge Server Claimsphere Facets (TriZetto) or similar payer platforms Experience with predictive analytics / data science applications in healthcare Background in risk adjustment, quality improvement, or value-based care programs SQL, data modeling, or advanced analytics tool experience #LI-DT1 #LI-Remote Position Level Consultant Country United States of America At Huron, we're redefining what a consulting organization can be.

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