What are the responsibilities and job description for the Risk Adjustment Analyst, Senior position at Blue Shield of California Careers?
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!
Your Role
Blue Shield’s Risk Adjustment (RA) team plays a crucial role in bringing health care into the digital age. The Risk Adjustment Consultant, Senior will report to the Manager, Actuary. The main job responsibilities will support Blue Shield’s risk adjustment program through data submissions to Centers of Medicare & Medicaid Services (CMS).
Your Work
In this role, you will:
- Analyze information for core principles and functionality of decision, descriptive and predictive analytic methods including forecasting, statistical and machine learning techniques
- Train lower-level analysts on how to update and apply these advanced analytic techniques
- Contribute to successful programs for the team, engaged multiple areas related to vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
- Lead data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
- Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
- Use various programming languages including SQL, SAS to perform data analysis
- Analyze, debug different and unique claims, encounters, pharmacy, and enrollment data sets
- Perform end to end reconciliation across various data warehouses and storages
- Provide insight into data trends and outliers
- Requires a bachelor’s degree or equivalent experience
- Requires at least 3 years of professional experience
- Requires at least 3 years of SQL, SAS or equivalent programming experience
- Requires at least 3 years of data analysis experience
- Experience in translating business requirements to technical requirements preferred
- Experience in Edit, Load, Transform (ETL) datasets preferred
- Knowledge of healthcare claims, encounters, enrollment data preferred
Our Values
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.