Medicare Advantage Stars SME

About the role

We are seeking a Medicare Advantage (MA) Stars Subject Matter Expert (SME) with deep knowledge of the Medicare Advantage quality, regulatory, measurement, and performance environment. This individual will serve as a subject matter bridge between Medicare Advantage health plans, quality organizations, data/analytics teams, and technology/product development teams. This is a highly collaborative role for someone who can move comfortably between CMS regulations and technical product requirements, plan quality strategies and data analysis, and business needs and technology development. The ideal candidate is someone who can read a 100-page CMS technical document in the morning and explain to a software developer that afternoon exactly what needs to be built — someone who understands not only what CMS requires, but how those requirements affect a health plan's operations, data, quality strategy, technology, and Star Rating. The strongest candidates combine three capabilities: deep Medicare Advantage Stars expertise, the analytical ability to turn performance results into actionable insight, and the technology/product fluency to translate regulatory and business requirements into working solutions. This role is particularly well suited for a Medicare Advantage quality professional who wants to move beyond traditional quality operations and play a central role in building the next generation of Medicare Advantage Stars technology and analytics solutions.

Responsibilities

• Medicare Advantage Stars Subject Matter Expertise: Interpret and explain CMS MA and Part D Stars regulations, technical specifications, and guidance — including Advance Notices, Final Rules, Rate Announcements, and Technical Notes; Assess how changes to Stars measures, methodology, benchmarks, cut points, and weighting affect health plans, and translate those implications into practical terms; Serve as the internal expert on Medicare Advantage quality measurement and performance improvement
• Product & Technology Development: Define business and functional requirements for MA Stars technology and analytics products, translating regulations and measure specs into data requirements, workflows, and calculations; Partner with product managers, data scientists, and engineers to ensure technology solutions accurately reflect CMS requirements, reviewing designs and outputs for regulatory accuracy; Help build tools that identify performance gaps and forecast Star Ratings, and support user acceptance testing to validate Stars-related functionality
• Health Plan Engagement & Quality Improvement: Engage directly with MA health plans to understand their Stars strategies, quality challenges, and data environments; Analyze plan performance to identify improvement opportunities, gaps, and root causes, and help develop targeted interventions; Present complex Stars findings clearly to plan executives, quality leaders, and both technical and non-technical audiences
• Data Analysis & Performance Analytics: Analyze MA quality and Stars data to evaluate measure-level performance, benchmarks, cut points, and year-over-year trends; Collaborate with data analysts and scientists to develop Star Ratings forecasts and quality improvement insights, validating that methodologies align with CMS requirements; Translate analytical findings into recommendations for health plans and product development teams
• Cross-Functional Leadership: Serve as the key Stars SME across product, technology, analytics, consulting, sales, and client engagement teams; Educate internal teams on Medicare Advantage Stars requirements and emerging regulatory changes, and contribute to client presentations and proposals; Help establish best practices for incorporating CMS requirements into technology products and