Lead Analyst, National Risk Adjustment Predictive Analytics

About the role

The Lead Analyst, National Risk Adjustment Predictive Analytics is responsible for leading advanced analytics supporting enterprise-wide healthcare risk adjustment strategies. Key responsibilities include transforming complex healthcare data into actionable insights, developing predictive models, and measuring intervention outcomes.

Responsibilities

• Lead analytical support for prospective and retrospective risk adjustment intervention strategies, including tracking progress, outcomes, and financial or operational impact.
• Design and develop systems to track risk scores, intervention outcomes, market performance, and results across multiple lines of business.
• Develop automated and ad-hoc quality assurance reporting modules supporting Medicaid, Marketplace, Medicare, and Medicare-Medicaid programs.
• Support the development of automated suspect, targeting, and ranking engines to identify opportunities for risk adjustment interventions.
• Analyze complex healthcare datasets, including claims, pharmacy, laboratory, utilization, financial, and performance data, using data mining, validation, scrubbing, and root-cause analysis techniques.
• Identify anomalies, outliers, changing trends, and improvement opportunities using statistical methodologies, and translate findings into concise executive-level recommendations.
• Apply extrapolation, interpolation, forecasting, and other analytical techniques to predict trends in cost, utilization, risk scores, and performance.
• Partner with cross-functional stakeholders and leaders to define business requirements, clarify data needs, communicate findings, and escalate issues when appropriate.
• Conduct preliminary and post-implementation impact analyses for changes to analytics logic, source code, reporting modules, and data warehouse platforms.
• Manage changes and upgrades to data warehouse and analytics environments while maintaining continuity and transparency for end users.
• Support special projects requested by internal teams, regulatory bodies, contracting organizations, and other external stakeholders.
• Monitor applicable CMS and state risk adjustment regulations, incorporate regulatory changes into analytics activities, and provide training and education as needed.
• Develop training materials and deliver guidance to help analysts understand analytical processes, solutions, and reporting designs.
• Train new and existing team members while promoting a collaborative, agile, and continuous-improvement culture.

Requirements

• Minimum of 4 years of experience developing complex SQL queries, functions, procedures, and data designs within relational database environments.
• Hands-on experience with Microsoft T-SQL, Databricks SQL, Power BI, SQL Server Integration Services (SSIS), and SQL Server Reporting Services (SSRS).
• Experience applying predictive modeling, statistical analysis, forecasting, and performance tracking techniques within healthcare, quality, HEDIS, risk adjustment, finance, or health plan environments.
• Demonstrated ability to work with complex datasets and quantify financial, utilization, operational, and performance metrics.
• Experience with cloud or distributed data platforms such as Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Strong analytical thinking, attention to detail, problem-solving ability, and experience performing structured root-cause analysis.
• Strong business acumen with the ability to connect analytical findings to broader strategic and operational objectives.
• Excellent communication skills, including the ability to explain complex technical and analytical concepts to non-technical stakeholders and executives.
• Prioritization and meeting deadlines in a fast-paced, agile environment.
• Self-directed approach, strong ownership, adaptability, and a continuous-improvement mindset.
• Strong written and verbal communication skills and proficiency with Microsoft Office applications.
• Familiarity with Python and R programming or broader data science techniques is preferred.

Benefits

A competitive annual salary range of $72,370.82–$156,803.45, with actual compensation dependent on factors such as geographic location, experience, education, and skill level. Full-time employment with a U.S.-based opportunity. Exposure to advanced predictive analytics, risk adjustment, forecasting, data engineering, and business intelligence initiatives. Collaboration with cross-functional healthcare, analytics, finance, quality, and business teams. Professional development through training, knowledge sharing, and opportunities to contribute to strategic analytical projects.