[Hiring] HEDIS Measure Owner (Abstractor) @Clover Health

Role Description

We are seeking a HEDIS Measure Owner (Abstractor) that will be responsible for the end-to-end performance of assigned HEDIS measures, with a primary focus on achieving and sustaining 5-Star performance. This role goes beyond traditional chart abstraction and serves as a measure-level owner, accountable for ongoing monitoring, medical record abstraction, gap identification, and driving targeted interventions to improve outcomes.

A key function of this role is to translate data and chart findings into actionable insights for providers, ensuring that care gaps are clearly identified and surfaced through tasks or alerts within clinical workflows. The goal is to simplify decision-making for providers, reduce administrative burden, and allow more time for direct patient care. The associate will function as a subject matter expert (SME) and partner cross-functionally with data, clinical, and provider engagement teams to ensure accurate reporting, efficient workflows, and optimal performance.

As a HEDIS Measure Owner, you will:

• Own assigned HEDIS measure(s) with accountability for 5-Star performance.
• Monitor performance regularly, including: current rates and trends, gap-to-goal analysis, hits needed to achieve target performance.
• Review and abstract medical records as they are received.
• Maintain productivity expectations of 60–80 charts per day.
• Document findings accurately and aligned with NCQA HEDIS technical specifications.
• Conduct random audits of incoming data streams to validate completeness and accuracy.
• Partner with providers & clinical teams to close care gaps.
• Provide insight into chart findings, documentation gaps, and missed opportunities.
• Act as a liaison between abstraction, clinical, and provider workflows.
• Validate data & collaborate cross-functionally to improve accuracy.
• Collaborate with data and analytics teams to validate accuracy of data sources and identify gaps between claims, supplemental data, and chart findings.
• Serve as a subject matter expert (SME) on HEDIS measures and requirements.
• Serve as SME for grouping of assigned HEDIS measures across women's health, cardiovascular health, diabetes care, care transitions and management, or preventive screening.
• Maintain deep knowledge of: HEDIS technical specifications, Medicare Advantage STAR ratings, value sets and documentation requirements.
• Provide guidance to internal teams on measure interpretation and compliance.

Success in this role looks like:

• First 90 days: Rapidly ramp on the Clover Assistant platform and assigned HEDIS measures, consistently reviewing 60-80 charts per day with strong accuracy. Begin contributing to gap closure by identifying care gaps and reliably translating findings into compliant, high-quality outputs.
• First 6 months: Proactively surface care gaps, near misses, and incomplete services, and convert insights into actionable provider interventions within CA and EHR workflows. Partner cross-functionally to improve gap closure strategies, refine provider alerts, and enhance data and reporting logic.
• First year: Drive meaningful improvements in quality performance, including progress toward 5-Star measures, while reducing provider administrative burden. Prioritize high-impact actions that streamline workflows, minimize unnecessary documentation, and enable providers to focus more on patient care.

Qualifications

• At least 2+ years of HEDIS Abstraction Experience.
• Strong knowledge of Medicare Advantage and HEDIS measures and technical specifications.
• Strong analytical and problem-solving skills.
• Accountability and ownership mindset.
• Strong attention to detail, data, and documentation accuracy.
• Effective communication and collaboration.
• Ability to translate data and chart findings into actionable insights.
• Ability to work effectively in a remote environment.

Requirements

• Associate’s or Bachelor’s degree in healthcare-related field (or equivalent experience).
• Experience with HEDIS abstraction tools.
• Experience working with EHR systems and provider workflows.
• Exposure to STAR ratings performance strategy.

Benefits

• Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy.
• Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents.