[Hiring] Senior Data Risk Adjustment Analyst @CareFirst

Role Description

The purpose of a Sr. Data Analyst is to support the Health Services Risk Adjustment team through advanced analytics, reporting, and data-driven insights that enhance program performance and operational effectiveness. This position is responsible for developing and maintaining trusted data assets, producing meaningful analyses and reporting, and partnering with clinical, operational, financial, and technology teams to support Risk Adjustment initiatives across the organization.

• Analyze program performance and monitor key performance indicators.
• Support risk score forecasting.
• Develop member and provider targeting methodologies.
• Create and maintain dashboards and reporting solutions.
• Perform CMS, HHS, and MDH data reconciliations.
• Conduct ad hoc analyses to identify opportunities for improvement.
• Translate complex data into actionable insights while adhering to established data governance, compliance, and quality standards.

The ideal candidate will possess strong analytical and problem-solving skills, experience working with large healthcare datasets, and a solid understanding of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies.

We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

Qualifications

• Bachelor's Degree in Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• 5 years experience in an analytical/quantitative role.

• Experience in Healthcare Industry.
• Hands-on experience with Big Data/NoSQL Platforms with experience delivering production projects at scale.
• Proficiency with SQL, Power Bi, Fabric, Python, and/or SSMS.

• Quantitative, analytical and problem-solving skills.
• Knowledge and understanding of analytical tools, languages, applications, platforms.
• Excellent communication skills both written and verbal.
• Ability to learn quickly and take direction.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Requirements

• Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff.
• May lead a team of matrixed resources.

Benefits

• Salary Range: $87,264 - $173,316.
• Comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Physical Demands

• The associate is primarily seated while performing the duties of the position.
• Occasional walking or standing is required.
• The hands are regularly used to write, type, key and handle or feel small controls and objects.
• The associate must frequently talk and hear.
• Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.