Healthcare Statistical Analyst I/II/III/IV (VBP)

About the Role

The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department to support the Health Plan's operations. This role monitors and maintains financial solvency by understanding current data and modeling future events. The position interacts with internal and external partners, including regulatory agencies, to monitor trends, identify opportunities, and provide insights from data. It supports leadership by delivering statistical information and analysis for informed decision-making, identifying trends, and utilizing data mining techniques and advanced predictive models.

Responsibilities

• Update existing and create new analyses related to benefit designs, claims experience, Value Based Payment (VBP) programs, and valuation of internal and externally led claims savings and risk adjustment initiatives.
• Maintain existing processes, including reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, and ROI work.
• Create and maintain appropriate documentation for all work.
• Assist in developing projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates, and identification of areas for savings.
• Compile and analyze data to draw conclusions, support data quality, and provide recommendations.
• Propose and assist in developing process improvements using system and software applications.
• Participate in activities and projects as directed.
• Demonstrate high standards of integrity by supporting the company’s mission and values, adhering to the Corporate Code of Conduct, and upholding company values.
• Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
• Ensure regular and reliable attendance.
• Perform other functions as assigned by management.

Level II Responsibilities (in addition to Level I)

• Conduct analyses for and communicate with other departments on various initiatives.
• Assist in developing analyses concerning complex issues and trends, coordinating with staff.
• Participate in reviewing and evaluating emerging trends in healthcare, establishing reserves, and producing financial analysis.
• Recommend appropriate applications and process changes for existing and new analyses.
• Reconcile Data Warehouse data with corporate financials or encounter submissions and identify corrective actions for data integrity issues.
• Initiate and lead efforts to improve data capabilities and the quality of department analysis and reporting.
• Independently ideate process improvements and recommend changes to leadership.
• Create and maintain documentation related to data analysis, data models, and data mapping, including technical documentation, process documentation, and training materials.
• Synthesize facts and input from a variety of data sources.

Level III Responsibilities (in addition to Level II)

• Review and ensure pricing aligns with established profitability targets for relevant business segments.
• Research and analyze data across complex data ecosystems, including operational and analytical data platforms, to develop insightful reporting and dashboards.
• Demonstrate keen judgment on complex assignments, devising methods and procedures to address unusual conditions and contribute original solutions to difficult problems.
• Develop analyses concerning complex issues and trends, coordinating with multiple disciplines and staff.
• Lead and support departmental projects.
• Provide effective technical advice and support to assist management in meeting corporate goals and identifying strategy, involving other departmental areas as needed.

Level IV Responsibilities (in addition to Level III)

• Recommend departmental annual performance goals.
• Offer strategic recommendations on data analysis, data collection, and integration using knowledge of best practices and business requirements.
• Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques.
• Represent the department on special projects involving other areas of the company or external constituents.
• Partner and lead projects including stakeholders from a variety of departments.
• Interpret how regulatory changes affect the Health Plan and develop impact analyses.
• Collaborate with senior leadership in meeting corporate goals and strategic decision-making.

Requirements

• Bachelor’s Degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science, or a relevant field.
• Strong analytical, verbal, and written communication skills.
• Strong interpersonal skills with demonstrated ability and willingness to collaborate with other team members.
• Ability to prioritize, multitask, and manage multiple simultaneous projects.
• Intermediate technical skills, including proficiency in Microsoft Office Suite.
• Programming skills in SQL, SAS, VBA, or similar programming language is preferred.

Level II Requirements (in addition to Level I)

• Two (2) years of related experience.
• A strong understanding of health insurance and health insurance products, managed care, accounting principles, the competitive market, the legislative environment, and regulatory issues affecting the Health Plan.
• Ability to work independently with a high level of self-motivation to improve processes.
• Proficient programming skills in SQL, SAS, VBA, or similar programming language.
• High-level understanding of non-actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Analytics & Data Technology, Population Health Engagement, Marketing & Sales, and their impact on Health Plan operations and financials.

Level III Requirements (in addition to Level II)

• Four (4) years of related experience.
• Ability to perform complex modeling independently.
• Strong ability to recognize and automate repetitive tasks.
• Ability to communicate analytical findings at the appropriate level of detail for the audience.
• Demonstrated experience leading projects or process improvement initiatives.
• Ability to write and communicate complex concepts.

Level IV Requirements (in addition to Level III)

• Six (6) years of related experience.
• Advanced understanding of non-actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, and their impact on Health Plan operations and financials.
• Advanced ability to independently communicate analytical findings at the appropriate level of detail for the audience.
• Strong ability to independently write, communicate, and present complex concepts to both actuarial and non-actuarial audiences.

Physical Requirements

• Ability to work while sitting and/or standing at a workstation, viewing a computer, and using a keyboard, mouse, and/or phone for three (3) or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Pay

Compensation ranges by level:

• Level I: Minimum $62,400 - Maximum $84,000
• Level II: Minimum $62,400 - Maximum $106,929
• Level III: Minimum $71,880 - Maximum $129,384
• Level IV: Minimum $79,068 - Maximum $142,322

Actual salary will vary depending on factors including budget available, prior experience, knowledge, skill, education, and internal equity.

Benefits

• Group health and/or dental insurance.
• Retirement plan participation.
• Wellness program.
• Paid time away from work and paid holidays.

Remote work opportunities may be available on a case-by-case basis.