Associate Director, Risk Adjustment Data and Analytics

Director of Risk Adjustment Data and Analytics Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment Data and Analytics is responsible for developing and executing the analytic plan for the Medicare and Merged Market segments. The role oversees the reporting, analytics, and management of risk adjustment internally and externally, and leads the strategy, execution, and performance of Medicare risk adjustment reporting and analytics, infrastructure, and systems to meet business objectives. The leader partners with Actuarial and Provider Contracting, manages external vendors, and ensures compliance with CMS regulations. This position is responsible for analysis, projections, and assessment of risk adjustment performance. Responsibilities Lead the Risk Adjustment Performance and Strategic Analytics Team and the Risk Adjustment Data and Analytics Team. Design and develop metrics, reports, and dashboards to drive key strategic and tactical decisions, ensuring resource alignment and workload balance. Coordinate risk adjustment analytics across the broader organization. Investigate risk adjustment trends across enrollment, providers, and claims to suggest business improvements and efficiencies. Represent the Risk Adjustment Team on internal workgroups and committees focused on reporting, analytics, and operations. Ensure business deliverables are met and risk adjustment data is provided to Government Programs leaders and internal business leaders to inform strategic initiatives. Act as the primary contact for facilitating resolution of urgent issues and escalations through analysis and reporting. Drive innovation and improvements through deep‑dive analytics, enhancing risk adjustment processes, increasing efficiency and productivity, and improving overall plan performance. Oversee the assessment of reporting requests, compilation, and distribution of routine and ad hoc reports for internal and external constituents. Coach, mentor, and develop analytic team members to increase their skill sets, subject‑matter knowledge, and effectiveness. Oversee submission of BCBSMA’s Encounter Data to CMS and resolve errors. Represent the Risk Adjustment Team’s interests through influence and negotiation in cross‑functional workgroups with a technology focus or related to new projects. Qualifications Excellent knowledge of Medicare risk adjustment models. Knowledge of Medicare and risk adjustment data and system interfaces. Proficiency in SAS/SQL; experience with Python, R, Tableau, and analytic automation preferred. Demonstrated attention to detail, quality results, and collaborative teamwork. Experience managing technology‑related projects with vendors, IT, and corporate partners. Proven success in managing people and achieving business goals. Strong working relationships and influence skills across key internal constituents. Documented analysis, problem‑identification, and problem‑resolution strengths. Track record of meeting timelines, deliverables, and quality results. Strong organizational skills, ability to work under pressure, multitask, and prioritize workload. Ability to identify, communicate, and manage risk. Effective presentation, facilitation, project management, and planning skills. Education / Relevant Experience Bachelor’s degree required; Master’s degree preferred. Minimum 7 years of Medicare risk adjustment experience. Minimum 5 years of progressive leadership experience preferred. Project Management and IT experience a plus. Highly organized with the ability to handle multiple projects simultaneously. Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above. Location: Boston, Hingham Time Type: Full time Salary Range: $151,200.00 - $184,800.00 We offer a comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well‑being benefits to eligible employees. #J-18808-Ljbffr Blue Cross Blue Shield of Massachusetts