Risk Adjustment Health Data Analyst

About Blue Cross and Blue Shield of Nebraska

Blue Cross and Blue Shield of Nebraska is a mission-oriented organization committed to improving the health and well-being of its members and the communities served. Our dedicated team plays a crucial role in fulfilling this commitment by adapting to the rapidly changing healthcare industry and seeking innovative solutions to optimize business operations and enhance customer experiences. Joining Team Blue offers a purposeful career with growth opportunities and the support necessary to impact the community positively.

Role Overview

The Healthcare Analytics position supports the Risk Adjustment Programs by examining healthcare data to assess program effectiveness, financial outcomes, and clinical impact. This role is responsible for generating reports, forecasts, and practical recommendations that shape Risk Adjustment strategies, guide intervention plans, and assist operational decision-making.

Work Location

This position offers hybrid or fully remote arrangements for candidates residing in Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, or Texas.

Key Responsibilities

• Evaluate healthcare claims, pharmacy, lab, and Risk Adjustment submissions to measure the effectiveness of interventions and programs.
• Create and maintain reports that track intervention return on investment, additional conditions identified, risk score influence, revenue effects, and other critical Risk Adjustment metrics.
• Collaborate with internal teams to address analytics needs, aid intervention planning, enhance reporting functions, and resolve related issues.
• Keep abreast of developments in healthcare analytics, Risk Adjustment methodologies, tools, and regulations; suggest improvements in processes or reports as appropriate.
• Independently provide analytic solutions for ad-hoc inquiries with minimal guidance from senior analysts.

Required Qualifications

• Bachelor’s degree or equivalent educational qualification.
• Over three years of experience in data or statistical analysis, or managing and interpreting data related to Government programs such as Medicare Advantage or Commercial ACA, including handling healthcare datasets like claims, encounters, provider data, CMS files, or EDGE response files.
• Proficiency in SQL and overall data analytics skills.
• Experience working with Microsoft Azure DataBricks platform.
• Advanced capabilities in Microsoft Excel.
• Strong analytical aptitude for extracting, manipulating, and interpreting diverse data types to produce meaningful insights.
• Experience collaborating successfully across multiple functions within an organization.
• Effective communication abilities when engaging with various stakeholder groups.

Preferred Skills and Qualifications

• Familiarity with Agile methodologies and/or project management approaches.
• Proven track record in developing analytic models based on data trends, calculating program ROI, and performing data quality assessments.
• Competence in translating data insights into clear reports and visual presentations trusted for business decisions.
• Experience designing and delivering self-service analytic content.
• Advanced expertise in SQL.
• In-depth understanding of Health Insurance Operations including claims processing, enrollment, payment mechanisms, care management, and employer reporting.
• Strong knowledge of Medicare Advantage risk adjustment models, associated concepts, payment methods, and submission rules.
• Ability to perform sophisticated calculations to transform datasets into actionable information.
• Experience with data manipulation languages/tools such as R and/or Python is highly desirable.
• Proficiency in visualization best practices and tools, for example Power BI and/or Tableau.
• Skilled in translating technical requirements into business deliverables.
• Competence in managing relationships with external partners including vendors, providers, groups, and brokers.
• Master’s degree in Business, Analytics, Information Technology, or related fields is preferred.

Diversity and Inclusion

The organization values diversity in experience, backgrounds, and perspectives, believing it fosters a more effective workplace and enhances customer and member products.