Senior Product Manager / Engineer - HEDIS SME

Key Responsibilities

• 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

• 7–12+ years of healthcare payer experience, with strong domain expertise in:
• HEDIS reporting
• CMS STARs methodology
• Regulatory reporting and quality programs
• Proven 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
• SQL, data modeling, or advanced analytics tool experience