Senior Analyst, Medicare Stars – Pharmacy Programs

Role Overview

• Own Part D Stars analytics end-to-end. Serve as the single-threaded owner for Stars performance, tracking KPIs and ROI across pharmacy programs — ensuring outputs directly inform interventions and business decisions.
• Build and maintain data infrastructure. Design, optimize, and QA SQL-based pipelines and datasets across claims, pharmacy, and vendor sources. Partner with Data Engineering on architecture, automation, and documentation aligned to CMS (Centers for Medicare and Medicaid Services), PQA (Pharmacy Quality Alliance), and internal standards.
• Generate and communicate insights. Analyze Part D Stars measures to identify trends, gaps, and early warning signals. Translate findings into clear recommendations and build dashboards that support both operational and executive decision-making.
• Evaluate programs and vendors. Design test-and-learn frameworks to assess the effectiveness of Stars campaigns, pharmacy interventions, and vendor programs. Define success metrics, run cohort analyses, and apply learnings to future improvements.
• Enable cross-functional partners. Act as the primary analytics partner for Pharmacy Stars Operations and vendor teams. Bridge business needs to technical teams, and partner with Product and Engineering to integrate insights into Counterpart Assistant and provider workflows.
• Build operational structure. Establish standardized analytics workflows, SOPs, and intake processes. Drive consistent use of measure logic and business rules across teams to support a scalable performance management cadence.

Requirements

• 4–6+ years of experience in healthcare analytics, with direct exposure to Medicare Advantage Part D measures, PQA specifications, and pharmacy data.
• Proficient in SQL and experienced building, validating, and QA-ing complex datasets across claims, pharmacy, eligibility, and vendor sources.
• Evaluated programs, interventions, or vendor performance using structured measurement frameworks — and can connect the findings back to business decisions.
• Familiar with CMS Stars, HEDIS, CAHPS, and regulatory requirements, and can work within BI tools like Tableau, Looker, Power BI, or Mode.
• Communicate clearly across technical and non-technical audiences and can translate complex data into actionable insights for stakeholders at all levels.

Tech Stack

• SQL
• Tableau

Benefits

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!