Star Rating Business Analyst

Blue Cross & Blue Shield of Rhode Island is dedicated to improving healthcare for Rhode Islanders. The Star Rating Business Analyst is responsible for advanced analytics, reporting, and performance measurement to support Medicare Advantage Star Ratings performance improvement, translating complex data into actionable insights.

Responsibilities:

• 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

Requirements:

• 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
• 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
• Proficiency in SQL preferred
• Experience with Snowflake or other cloud-based data platforms
• 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