Senior Risk Adjustment Analyst

Senior Risk Adjustment Analyst

Location: Norfolk VA, Mason OH, Indianapolis IN, Louisville KY, Grand Prairie TX, Tampa FL, Atlanta GA

Hours: Standard working hours

Travel: This role requires associates to be in-office 1 – 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Position Overview

The Senior Risk Adjustment Analyst is a high-impact individual contributor on Elevance's Medicare Advantage Risk Adjustment team, reporting directly to the Staff VP of Analytics/Decision Support. This role is responsible for conducting advanced data analysis, building and maintaining HCC performance reporting, supporting predictive modeling initiatives and monitoring vendor performance. The Sr. Analyst serves as a key analytical resource, translating complex data into actionable insights for both clinical and operational stakeholders.

How You Will Make an Impact

• Design, develop, and maintain risk adjustment performance dashboards and reports using Power BI, Tableau, or equivalent tools to monitor KPIs
• Write and optimize complex SQL queries to extract, transform, and analyze large datasets from data warehouses and payer/provider data systems
• Support the development and validation of predictive models for HCC suspecting, risk score forecasting, and provider performance stratification
• Prepare and present analytical findings, trend analyses, and performance summaries to key internal stakeholders
• Mentor junior analysts and coordinators, providing guidance on analytical methods, data interpretation, and risk adjustment concepts
• Support cross-functional initiatives in quality, population health, provider engagement and finance as they relate to risk adjustment analytics
• Maintains active relationships with customers to determine business requirements, leads requirement meetings
• Proactively addresses customer issues, prepares alternatives and implements solutions
• Collaborates with engineers for creative ideas for supporting interactive content, analyzes and classifies complex change request and reviews and evaluates possible enhancements
• Identifies and manages risks and develops contingency plans
• Partners with business, architecture and infrastructure and oversees all service levels
• Develops and defines application scope and objectives, including impact to interfaces
• Analyzes and evaluates detailed business and technical requirements
• Mentors others on coding standards and performs code reviews
• Supervises others on developing application internals for usability, reliability and scalability requirements
• Ensures system testing is completed and meets the test plan requirements
• Coordinates integration activities with other IT to ensure successful implementation and support of project efforts
• Assesses current status and supports BI planning efforts
• Mentors and assists in training initiatives and performs estimates for costs and impacts
• Manages small to medium projects, potentially leading global projects
• Mentors and provides training, conducts vendor evaluations and manages pilots for Business Intelligence tool upgrades

Required Qualifications

• Requires a BA/BS degree in Information Technology, Computer Science or related field of study and minimum of 5 years experience with multi platform, two or more BI applications and/or multiple Business Intelligence tools required; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications

• Medicare Advantage or commercial Risk adjustment data analysis experience is a must have
• SQL experience strongly preferred
• Intermediate Excel experience preferred
• Power BI experience is nice to have