Senior Insights Analyst

🕒 September 29

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $98.1k - $156.9k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Provide advanced analytical support for ACA risk adjustment • Perform data collection, model implementation, trending, forecasting, validation, reporting, and financial reconciliation • Prepare and interpret complex data for internal and external customers • Investigate discrepancies across data sources and systems and translate findings into business insights • Partner with Actuarial, regulatory submission, value-based program, vendor, and operational stakeholders • Use SQL, Python, and approved platforms to access, investigate, validate, and analyze complex healthcare data • Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production • Perform trend, variance, and root-cause analysis of risk scores, transfer estimates, regulatory submission results, and provider settlement outputs • Reconcile outputs across analytical processes and source systems and coordinate issue resolution • Manage analytical applications across multiple platforms and coordinate code migrations between environments • Develop analytical processes, controls, reports, and tools to improve accuracy, repeatability, and transparency • Optimize report-generation processes, including data ingestion, manipulation, profiling, validation, and documentation • Collaborate with customers to complete analyses and provide problem-solving support • Identify trends and make recommendations for financial, operational, regulatory, and strategic decisions • Present findings, risks, and recommendations to technical and non-technical audiences, including leadership • Represent the department on cross-functional project teams and process optimization efforts • Coordinate analytical support for external vendor engagements and validation activities • Provide user support for ad hoc reporting, data inquiries, and analytical problem resolution • Mentor or coach less experienced employees and contribute to cross-training and knowledge continuity

🎯 Requirements

• Bachelor's degree or advanced degree (where required), or 7+ years of experience in related field in lieu of degree • 5+ years of experience in related field • Experience with healthcare analytics, preferably ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or related regulatory analytics • Advanced SQL skills • Experience using Python or comparable analytical tools to develop, validate, and maintain complex, repeatable data processes • Ability to validate member-level risk scores or other financially significant outputs • Experience reconciling results across systems and performing root-cause analysis of discrepancies • Experience translating complex results into clear insights for Actuarial, Finance, regulatory, operational, or provider-facing stakeholders • Experience supporting recurring processes with overlapping deadlines and high accuracy requirements • Ability to create documentation, controls, peer-review routines, and process improvements • Ability to independently lead analytical work and coordinate across cross-functional teams and external vendors • Ability to communicate risks and recommendations • Ability to operate effectively with limited supervision during critical business cycles • Ability to ensure security and privacy of protected health information in accordance with company requirements

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401(k) match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO)