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Blue Shield of California · 12 hours ago

Risk Adjustment Consulting, Experienced

California, United States

Full-time

Hybrid

Mid Level

3+ years exp

Blue Shield of California is a nonprofit organization focused on transforming healthcare to be more affordable and effective. The Risk Adjustment Analyst, Experienced will be responsible for developing Risk Adjustment Suspecting logic, quantifying financial impacts, and ensuring accurate data submissions for Medicare Advantage and ACA Chart Review Programs.

Financial ServicesHealth InsuranceNon Profit

H1B Sponsor Likely

Responsibilities

Analyze under the supervision of the core principles and functionality of decision and descriptive analytics including analyzing historical data, past performance and trends

Develop and run programs that apply to decision analytic techniques

Contribute to successful programs for the team, engaged in typically one area related to vendor oversight, internal cross functional partnerships, tracking performance and measuring results

Continuously learn about plan data including claim, premium, membership, and risk score assignment

Conduct 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

Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports

Experience with HHS-Developed Risk Adjustment Model Algorithm for the Medicare Advantage and Commercial markets preferred

Qualification

Risk Adjustment AnalyticsData AnalysisHealthcare ExperienceSQLSASRPythonMS OfficeCommunication SkillsPresentation Skills

Required

Requires a bachelor's degree in mathematics, statistics, computer science or related field or equivalent business experience

Requires at least 3 years of professional experience in healthcare preferably in risk adjustment or actuarial

Requires practical knowledge of job area obtained through professional experience and advanced education

Requires proficiency with MS Office, including Excel, Word, PowerPoint

Excellent communication and presentation skills with the ability to translate complex information to cross-functional teams (e.g., vendor management, product, finance, compliance)

Preferred

Experience with HHS-Developed Risk Adjustment Model Algorithm for the Medicare Advantage and Commercial markets preferred

Familiarity with SQL, SAS, R, Python or other data analysis tools strongly preferred

Prior exposure to claims data, membership data, premium data, and risk score assignment processes strongly preferred

Company

Blue Shield of California

Glassdoor3.8

Blue Shield of California is a health insurance service provider.

Founded in 1939

San Francisco, California, USA

5001-10000 employees

https://www.blueshieldca.com

H1B Sponsorship

Blue Shield of California has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (1)

2022 (41)

2021 (20)

2020 (31)