Principal, Risk Adjustment Analytics Consultant

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

💵 $102k - $184.3k / year

⏰ Full Time

🔴 Lead

🎲 Risk

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Drive analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. • Deliver actionable insights, build dynamic visualizations, and provide strategic advisory services to internal stakeholders and senior leadership. • Analyze for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance. • Build interactive visualizations, interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics. • Translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership.

🎯 Requirements

• Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master’s degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field • Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc. • Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI. • High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution. • Excellent communication and presentation skills. • Ability to work independently and as part of a team. • Ability to lead multiple analytic related projects in parallel. • Analytics subject matter expert.

🏖️ Benefits

• health and wellness benefits • 401(k) savings plan • pension plan • paid time off • paid parental leave • disability insurance • supplemental life insurance • employee assistance program • paid holidays • tuition reimbursement • other incentives