Risk Analyst

Position Overview


The purpose of this position to MetroPlusHealth is to utilize the insurance plan's data to provide analysis and curated data extracts related to the provision of health care reporting as it pertains to the financial, contracting, quality, and reporting of health care services rendered. The position is also responsible for research collection, analysis and presentation of the Plan's utilization, quality and financial data. Candidates interested must work alongside multiple departments within the Plan in an effort to coordinate analytics to enhance operational efficiencies and data accuracy. The Analyst will work with internal and external stakeholders in quantifying and analyzing risk results and practice patterns to explain and financial performance and key drivers.


Scope of Role & Responsibilities

• Execute, deliver and maintain pre-existing scheduled reporting processes.
• Work alongside the Lead Risk Analyst on report creation, delivery and troubleshooting.
• Assist in the preparation and delivery of data to be incorporated into pre-existing reporting mechanisms.
• Work with staff to prepare analyses on various aspects of financial risk arrangements including value-based payment (VBP) arrangements, revenues, expenses, utilization, quality, and membership over time.
• Ingest, format, and store information received by external departments and actuaries for integration into downstream reporting.
• Create, update and maintain documentation on processes impacting pertinent business workflows across departments to inform staff and identify potential areas of improvement and/or to expand staff knowledge.
• Support staff on various initiatives as it pertains to VBP arrangements, finance, risk and quality.
• Prepare projection analyses on claims and utilization, including underlying trends and risk analysis.
• Prepare analyses of medical service from large, shared databases utilizing queries and multiple level extracts.
• Prepare financial analyses for providers based on their risk performance.
• Prepare financial historical and projection analyses for contracting proposals such as those related to value-based contracting.
• Ensure critical risk affiliations are represented in our data and work with out I.T. staff to resolve any issues/discrepancies.
• Act as a liaison with provider finance and operations staff.
• Special projects and other related duties as assigned.

Required Education, Training & Professional Experience

• Bachelor's Degree or a minimum of 3 years of experience industry related (business, health care, consulting, insurance, government)
• Insurance operations experience preferred.
• Proficiency in Microsoft Excel, Access and Word are necessary.
• SQL Query skill is desired.
• Experience with statistical systems and data reporting.

Professional Compentencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent verbal, written and mathematical skills

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