Medicare 5 Star Analyst

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

B r ief summary of purpose:

The Medicare 5-Star Analyst is responsible for supporting Fallon Health's Medicare Star Ratings improvement strategy through advanced analytics, performance monitoring, reporting, forecasting, and operational consultation. This role serves as the organization's primary analytical resource for Medicare Star performance and works closely with Fallon Health's Stars analytics vendor, Hyperlift, to monitor performance projections, validate measure forecasts, identify improvement opportunities, and support strategic decision making. The Analyst serves as a subject matter expert on CMS Star Ratings, CAHPS, HOS, HEDIS, and related quality measures. Working closely with organizational leaders, business owners, and measure stewards, this position develops performance dashboards and exhibits, conducts trend analyses, identifies risks and opportunities, and provides actionable recommendations to improve Medicare Star performance. The Medicare 5-Star Analyst leverages data from trending and star results to help evaluate operational performance, monitor key performance indicators, quantify intervention effectiveness, and support enterprise-wide quality improvement initiatives. The role is responsible for translating complex data into meaningful business insights that drive informed decision-making and support Fallon Health's Medicare performance goals.

Location

Medicare 5 Star Analyst Location

US-MA-Worcester

Job Details

Job ID: 8548

# Positions: 1

Category: Medicare Medicaid Programs

Overview

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Primary Job Responsibilities

Medicare 5-Star Performance Management

• Serve as the primary analytical resource supporting Fallon Health's Medicare Star Ratings strategy.
• Monitor and evaluate performance across all CMS Star measures.
• Develop and maintain internal dashboards, exhibits and surveillance reports.
• Identify emerging performance risks, opportunities, and trends affecting Star Ratings outcomes.
• Track measure-level interventions and assess effectiveness of improvement activities.
• Partner with business owners and department leaders to establish accountability and performance monitoring processes.
• Support annual Stars planning, goal setting, and performance reviews.
• Identify cultural trends, demographic patterns, disparities, and social determinants of health that may affect Medicare Star performance.
• Analyze provider practice patterns to identify performance variation, barriers, and improvement opportunities.
• Identify and define key performance indicators (KPIs), establish accountability tracking, and lead routine performance reviews.
• Manage and actively participate in meetings across all Medicare 5-Star domains, including agen