Star Rating Business Analyst
Pay Range: $65,600.00 - $98,400.00 Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: The Star Rating Business Analyst is responsible for advanced analytics, reporting, and performance measurement that directly supports Medicare Advantage Star Ratings performance improvement. This role translates complex healthcare and administrative data into actionable insights that inform strategy, prioritize interventions, and track progress across clinical quality, member experience, and operational measures. The analyst serves as a technical and analytical partner to Star Ratings program leadership, clinical and operational domain owners, and analytics stakeholders, applying sound Star Ratings knowledge and methodologies to reporting, forecasting, and performance improvement initiatives. What you will do: Partner with Star Rating program leadership, quality improvement teams, analytics colleagues, and vendors to support strategy development and evaluation of interventions. Synthesize large and complex healthcare datasets curated by enterprise data and analytics teams to identify performance drivers, risks, and opportunities for improvement across clinical quality, CAHPS/HOS, pharmacy, and operational measures. Translate complex Star performance analyses into clear, actionable insights and present findings to diverse audiences—including executives, governance forums, and cross‑functional partners. Design, develop, and maintain recurring and ad hoc Star Rating reports and performance summaries for leadership and cross-functional stakeholders. Apply deep understanding of Star Ratings specifications, methodologies, cut points, and CMS guidance to ensure analytical accuracy and business relevance. Develop and document analytical methodologies, assumptions, and business rules to ensure transparency, consistency, and audit readiness. Perform other duties as assigned. What you need to succeed: Bachelor’s degree in Analytics, Data Science, Computer Science, Mathematics, Economics, Public Health, or related field; or an equivalent combination of education and experience Three to five years of health data analysis, business analysis, or performance reporting. Demonstrated experience working with Medicare Advantage Star Ratings data and measures. Direct experience supporting Medicare Advantage Star Rating performance improvement analytics. Strong understanding of CMS Medicare Advantage Star Rating domains, including Clinical Quality (HEDIS), Member Experience (CAHPS/HOS), Pharmacy, and Operational measures. Hands-on experience working with Star Rating data sets such as medical and pharmacy claims, enrollment and eligibility, provider data, clinical quality/HEDIS outputs, and CAHPS/HOS survey data. Demonstrated ability to apply Star Ratings methodologies, measure specifications, scoring logic, and performance timelines (e.g., measurement year vs. payment year) to analytic work. Experience designing executive and governance ready Star Ratings reports and dashboards (e.g., Power BI, Tableau) that clearly communicate measure performance, trends, and improvement opportunities to technical and non-technical audiences. Experience leveraging Microsoft Copilot or other AI-assisted analytics and productivity tools to enhance analysis, reporting efficiency, and documentation in a regulated healthcare environment. Excellent verbal and written communications skills Good problem-solving skills Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects The extras: Strong understanding of CMS Star Ratings methodologies, measure specifications, and performance timelines. Experience with Snowflake or other cloud-based data platforms. Proficiency in SQL preferred Experience designing executive-ready reports and dashboards (e.g., Power BI or similar tools). Experience leveraging Microsoft Copilot or other AI-assisted analytics and productivity tools. Background in health insurance, Medicare Advantage, or regulated healthcare environments. Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster. Apply To This Job