Risk Adjustment Health Data Analyst - Insights & ROI

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The Healthcare Analytics role supports the Risk Adjustment Programs team by analyzing healthcare data to evaluate program performance, measure financial and clinical impact, and identify opportunities for improvement. This role develops reporting, forecasts, and actionable recommendations that inform Risk Adjustment strategy, intervention planning, and operational decision-making. Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas. What you'll do: Analyze healthcare claims, pharmacy, lab, and Risk Adjustment submissions data to evaluate intervention and program performance. Develop, maintain, and present reports that measure intervention ROI, incremental conditions captured, risk score impact, revenue impact, and other key Risk Adjustment performance metrics. Partners with internal teams to support Risk Adjustment analytics needs, intervention planning, reporting enhancements, and issue resolution. Stay current on healthcare analytics, Risk Adjustment trends, tools, methodologies, and regulatory considerations; recommend process or reporting improvements where appropriate. Provide analytic solutions on ad-hoc requests with little oversight by senior analysts. To be considered for this position, you must have: Bachelor's degree or equivalent 3+ years' experience in data or statistical analysis, or experience with managing and analyzing data for Government programs (Medicare Advantage, Commercial ACA) including experience working with healthcare-related data, such as claims, encounters, provider data, CMS files, EDGE response files, or similar datasets. Proficiency in SQL and data analytics. Experience with Microsoft Azure DataBricks. Advanced Excel skills. Strong analytic skills to construct impactful findings from the extraction, manipulation and understanding of various types of data. Successful experience working in a cross-functional environment. Experience effectively communicating with stakeholder groups. The strongest candidates for this position will also possess: Proficiency working within an environment that utilizes Agile and/or Project Management techniques. Successful experience with creating analytic models based on data trends, business program ROI, data Quality Analysis, etc. The translation of data findings into informative reports and visual outputs trusted by stakeholders to make business decisions. Experience designing or building self-service content. Advanced SQL knowledge. Understanding of Health Insurance Operations knowledge including claims, enrollment, payment mechanisms, care management, employer reporting and the ability to stay current on healthcare industry knowledge. Strong knowledge of the MA risk adjustment models, concepts, payment methodologies and submission requirements. Ability to use advanced-level calculations in the transforming of data sets into usable data. Ideal candidate would have experience using data manipulation tools such as R and/or Python. Proficiency of visualization best practices as well as Proficiency with visualization tools such as PowerBI and/or Tableau. Experience with Microsoft Azure DataBricks. Ability to translate technical requirements into business deliverables. Skilled in navigating relationships with external partners such as vendors, providers, groups, brokers, etc. Master's Degree in Business, Analytics, Information Technology or a Related Field. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members. #J-18808-Ljbffr Blue Cross Blue Shield of Nebraska