Senior Insights Analyst
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Job Description
Senior Insights Analyst driving ACA risk-adjustment analytics for Blue Cross NC. Validating risk scores, reconciling healthcare data, and guiding regulatory and financial decisions.
Responsibilities:
- Provide advanced analytical support for ACA risk adjustment
- Collect data, implement models, perform trending, forecasting, validation, reporting, and financial reconciliation
- Serve as the primary analytical resource for ACA risk adjustment activities
- Prepare and interpret complex data for internal and external customers
- Investigate discrepancies across data sources and systems and translate findings into business insights
- Partner with Actuarial, regulatory submission, value-based program, vendor, and operational stakeholders
- Improve analytical controls, documentation, automation, and recurring processes
- Use SQL, Python, and other approved platforms to access, investigate, validate, and analyze complex healthcare data
- Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production
- Perform trend, variance, and root-cause analysis
- Reconcile outputs across analytical processes and source systems and coordinate issue resolution
- Manage analytical applications across multiple platforms and coordinate code migrations and environment changes
- Develop analytical processes, controls, reports, and tools
- Optimize report-generation data ingestion, manipulation, profiling, validation, and documentation
- Provide analytical support and problem-solving assistance to business areas
- Make actionable recommendations for financial, operational, regulatory, and strategic decision-making
- Present findings, risks, and recommendations to technical and non-technical audiences, including leadership
- Represent the department on cross-functional project teams and process optimization efforts
- Coordinate analytical support for external vendor engagements and validation activities
- Provide user support for ad hoc reporting, data inquiries, and analytical problem resolution
- Mentor or coach less experienced employees and contribute to cross-training and knowledge continuity
Requirements:
- Bachelor's degree or advanced degree (where required), or 7+ years of experience in a related field in lieu of degree
- 5+ years of experience in a related field
- Experience with healthcare analytics, preferably ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or related regulatory analytics
- Advanced SQL skills
- Experience using Python or comparable analytical tools to develop, validate, and maintain complex, repeatable data processes
- Ability to validate member-level risk scores or other financially significant outputs
- Experience reconciling results across systems and performing 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
- Experience creating documentation, controls, peer-review routines, and process improvements
- Ability to independently lead analytical work and coordinate across cross-functional teams and external vendors
- Ability to communicate risks and recommendations
- Ability to operate effectively with limited supervision during critical business cycles
- Ability to ensure security and privacy for data containing protected health information
Benefits:
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- 401(k) match including an annual company contribution
- Annual Incentive Bonus
- Paid Time Off (PTO)
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