Senior Population Risk Performance Analyst – Value-Based Care

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $98.1k - $156.9k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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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

• Apply population risk and actuarial models to normalize performance measurement across value-based care programs • Operationalize CMS-HCC, Milliman, and comparable population risk methodologies for performance evaluation and financial measurement • Support development and maintenance of risk-normalized total cost of care and quality performance metrics • Validate performance measurement methodologies used in shared savings, downside risk, and alternative payment models • Analyze population risk movement and evaluate impacts on program financial performance and provider outcomes • Partner with actuarial and finance teams to align modeling assumptions with contractual measurement logic • Identify and investigate performance variances driven by population acuity, attribution changes, coding variation, or data completeness • Support performance year reconciliation, settlement calculations, and financial exposure analysis • Define and document measurement methodologies, assumptions, and model governance controls • Collaborate with analytics and data engineering teams to integrate risk modeling logic into reporting and measurement pipelines • Provide analytical expertise supporting provider performance reviews and measurement inquiries • Translate complex modeling outcomes into clear insights for operational and executive stakeholders • Ensure consistency and repeatability of population measurement processes across programs and performance periods • Serve as subject matter expert for population risk interpretation supporting value-based care strategy and operations

🎯 Requirements

• Bachelor's degree or advanced degree in healthcare administration, business, public health, or related field, or 7+ years of experience in lieu of degree • 5+ years of experience in related field • Demonstrated experience working with population risk models including CMS-HCC and Milliman methodologies (or equivalent) • Experience analyzing healthcare claims and eligibility datasets • Strong SQL and analytical data experience • Experience supporting Medicare Advantage and Commercial value-based care programs • Familiarity with total cost of care measurement and shared savings models • Experience collaborating with actuarial, finance, or clinical economics teams • Knowledge of attribution methodologies and population performance analytics • Experience supporting provider settlement or reconciliation processes • Authorization to work in the United States

🏖️ Benefits

• Annual Incentive Bonus • 401(k) with employer match • Paid Time Off (PTO) • Competitive health benefits • Wellness programs • Reasonable accommodations for applicants with disabilities