Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is seeking a Senior Insights Analyst to provide advanced analytical support for ACA risk adjustment. The role owns model implementation, validation, forecasting, reconciliation, discrepancy analysis, reporting, and stakeholder support while improving analytical controls, documentation, automation, and recurring processes.
Responsibilities
- Use analytical and reporting tools, including SQL, Python, and other approved platforms, to efficiently access, investigate, validate, and analyze complex healthcare data
- Develop, analyze, report, and interpret complex data for ongoing activities and projects while ensuring outputs are accurate, documented, and available within established deadlines
- Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production
- Perform in-depth trend, variance, and root-cause analysis to explain changes in risk scores, transfer estimates, regulatory submission results, and provider settlement outputs
- Reconcile outputs across analytical processes and source systems, identify discrepancies, and coordinate issue resolution with business, technical, and operational partners
- Support and manage complex analytical applications across multiple platforms and coordinate code migrations and changes between application environments
- Maintain and coordinate existing cross-functional programs and develop new analytical processes, controls, reports, and tools that improve accuracy, repeatability, and transparency
- Engineer efficient report-generation processes by optimizing back-end data ingestion, manipulation, profiling, validation, and documentation
- Work collaboratively with customers to complete effective analyses and provide analytical support and problem-solving assistance to business areas
- Identify complex trends and make actionable recommendations that assist business partners with financial, operational, regulatory, and strategic decision-making
- Present findings, risks, and recommendations clearly to technical and non-technical audiences, including all levels of leadership
- Represent the department on cross-functional project teams and process optimization efforts that require analysis, interviews, procedure design, documentation, and implementation
- Coordinate analytical support for external vendor engagements and validation activities, as assigned
- Ensure appropriate security and privacy for data containing protected health information and resolve identified security or privacy concerns in accordance with company requirements
- Provide ongoing user support for ad hoc reporting, questions, data inquiries, and analytical problem resolution
- Serve as a mentor or coach for less experienced employees and contribute to cross-training and knowledge continuity
Skills
- Bachelor's degree or advanced degree (where required)
- 5+ years of experience in related field
- In lieu of degree, 7+ years of experience in related field
- Analytical Analysis, Data Analysis, Data Analysis Reporting, Data Analytics, Data Engineering, Data Governance, Data Mining, Data Science, Identifying Trends, Trend Analysis
- Experience with healthcare analytics, preferably ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or related regulatory analytics
- Advanced SQL skills and experience using Python or comparable analytical tools to develop, validate, and maintain complex, repeatable data processes
- Demonstrated ability to validate member-level risk scores or other financially significant outputs, reconcile results across systems, and perform 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, including creating documentation, controls, peer-review routines, and process improvements
- Ability to independently lead analytical work, coordinate across cross-functional teams and external vendors, communicate risks and recommendations, and operate effectively with limited supervision during critical business cycles
Benefits
- The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
- Work-life balance, flexibility, and the autonomy to do great work
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
- Annual Incentive Bonus based on annual corporate goal achievement and individual performance
- Paid Time Off (PTO)
- Competitive health benefits and wellness programs
- Remote-Flex work arrangement with virtual work and a few in-office visits each year for meaningful moments that matter
Company Overview
Company H1B Sponsorship