Senior Health Care Analyst-Risk Adjustment

SUMMARY: The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments related to Medicare Risk Adjustment. This role involves analyzing clinical, claims, and enrollment data to ensure compliance with government regulations, identifying trends, and collaborating with cross-functional teams to improve risk adjustment strategies and processes. This position operates within broad objectives to ensure optimum utilization of manpower and budget. RESPONSIBILITIES/TASKS: Provide analytical support on prospective and retrospective initiatives, trends and identify areas for improvement. Uses a combination of data/text mining, analysis, reporting, predictive and risk modeling to support leadership and business decisions. Builds and supports business reports to be included in executive dashboard. Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues. Possesses and maintains an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles and methodologies.Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters. Develops lines of communication to discuss and review results of analysis to management via reports and presentations and assists management in implementing programs that provide solutions. Investigates, reviews, recommends, communicates, and implements solutions which identify problems/root cause of issues. Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities. Independently develops and plans reports, papers, and/or other materials in a clear and concise manner. Provides expertise and guidance to unit and corporate staff as required. Acts as a liaison between corporate business areas and participates in group or committee discussions. Supports ongoing maintenance of executive dashboard and related products, applications, and platforms, continuously striving towards automation. Works with analytics business analysts/developers and operations personnel to automate dashboard functions. Completes ad hoc data and analytic requests as assigned. Competent in SAS (Base, Macro, Graph, Email); Visio; Visual Basic for automation in Excel, Visio, Access, PowerPoint; SQL (Oracle, SQL/Server); ETL into Oracle; system tools (Windows/Linux command line coding, scheduling programs in both); creation of file structures (flat, delimited, etc.). This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION: Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Mathematics, or a related field. Master's degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. EXPERIENCE: Seven years experience in a related field, typically in two subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management). SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Knowledge of CMS Medicare HCC risk adjustment models and methodologies, ICD-10 coding, and interacting with large amounts of healthcare data. Working knowledge of data languages such as SAS,

Created: 2026-02-03