Senior Healthcare Data Analyst: ACA + EDGE

Job Description

We are seeking a highly skilled Senior Data Analyst with deep expertise in Affordable Care Act (ACA) Risk Adjustment and EDGE server submissions. This role will serve as a key liaison between business stakeholders, risk adjustment operations, and technical teams to ensure the accuracy, completeness, and timeliness of EDGE data submissions and reporting.

The ideal candidate will have strong experience with ACA data flows (enrollment, claims, supplemental), HCC modeling, and reconciliation of EDGE outputs, along with advanced analytical and data validation skills.

In this role you will be responsible for providing complex analytic support, which includes data collection, trending, reporting and forecasting functions to effectively assist departments/divisions with decision making. Prepares complex data for various internal and external customers, such as Department of Insurance (DOI), lawyers, external auditors, contracting vendors, employee groups, internal physician and hospital contracting staff, financial/medical expense staff and other divisions/programs.

What You'll Do

• Construct, design, write and document complex programs using Business Intelligence Tools (e.g. Business Objects, SAS, SQL, Crystal Reports) to gather statistical data, ensuring that the most efficient procedures are used to access, investigate, and analyze data.

• Develop, analyze, report and interpret complex data for ongoing activities/projects. Ensure that all data is accurate and available to meet establish deadlines.

• Work collaboratively with customers to complete effective needs analyses to successfully provide analytic support and problem solving assistance to business areas.

• Monitor and perform in-depth analysis of data for customers to determine areas of improvement or where investigation is needed.

• Identify complex data problems and issues and is responsible for resolution.

• Identify complex trends and make recommendations to business areas to effectively assist them with decision making on operational or other business issues.

• Communicate meaningful insights by creating charts and slide presentations and presenting findings to all levels of leadership staff.

• Maintain and coordinate existing cross-functional programs, and create and develop new programs.

• Support and manage complex applications systems on many platforms and manage code migrations and changes between different applications environments.

• Develop, maintain, and monitor reports on system security to ensure user access is appropriate for the specific division. Provide ongoing user support for ad hoc reporting, questions, queries, and problem support

• Ensure appropriate security and privacy for all data that contains PHI fields. Resolve all security and privacy issues in the data.

• Represent department on enterprise project teams and process optimization efforts as needed.

• Serve as a mentor/coach for less experienced employees.

What You Bring

* Bachelor's degree or advanced degree (where required)

* 5+ years of experience in related field.

* In lieu of degree, 7+ years of experience in related field.

What You 'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

Where You 'll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused.

In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00

Skills

Business Analysis, Business Data Analysis, Business Intelligence (BI), Cloud Applications, Code Collaborator, Communication, Consulting, Data Warehousing (DW), Health Insurance Industry, Peer Development, Problem Solving, Statistical Models, Structured Query Language (SQL)

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on talent.com .