Senior Insights Analyst

Job not on LinkedIn

🔥 1 minute ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $98.1k - $156.9k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

👻 Ghost score 0%

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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 • Collect data, implement models, perform trending, forecasting, validation, reporting, and financial reconciliation • Serve as the primary analytical resource for ACA risk adjustment activities • 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 • Improve analytical controls, documentation, automation, and recurring processes • Use SQL, Python, and other 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 • Reconcile outputs across analytical processes and source systems and coordinate issue resolution • Manage analytical applications across multiple platforms and coordinate code migrations and environment changes • Develop analytical processes, controls, reports, and tools • Optimize report-generation data ingestion, manipulation, profiling, validation, and documentation • Provide analytical support and problem-solving assistance to business areas • Make actionable recommendations for financial, operational, regulatory, and strategic decision-making • 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 a related field in lieu of degree • 5+ years of experience in a 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 • Experience creating 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 for data containing protected health information

🏖️ 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)