Medical Informatics Analyst, Consultant

About the role

The AI & Analytics (AI&A) team sits within the enterprise Growth organization, specifically aligned to the Risk Adjustment vertical. While situated within the Risk adjustment, this is strictly an advanced Medical Informatics and data architecture role. The Consultant will serve as a critical semantic bridge and analytical lead supporting multiple Government Lines of Business (LOBs) within Senior Markets with a distinct focus on Special Needs Plans (SNPs).

Responsibilities

• Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
• Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies
• Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
• Communicate project status, progress, and outcomes to executive management
• Serve as a technical mentor by reviewing SQL, SAS, and Python code of junior staff while working independently to drive complex portfolios forward with limited supervision
• Integrate AI-assisted development tools (such as GitHub Copilot) into daily coding workflows to accelerate deployment timelines, enhance code quality, and support automated pre-peer-review safety nets
• Lead complex medical claims analysis to support Cost of Health Care (CoHC) analytics, dissecting trends, cost drivers, and billing methodologies to identify optimization and recovery opportunities
• Improve member retention & conversion rates by collaborating with business partners to design and report from outreach tracking systems (e.g., PEGA, Salesforce) and conduct plan cost/value studies
• Improve Acquisition by leveraging data from Markets, Provider, Geo, and Operations tracking to target and execute strategies that drive multi-product growth as customers transition through different life stages

Qualifications

• Requires a college degree or equivalent experience
• Master’s degree preferred
• Minimum 7 years of prior relevant experience with 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures
• Requires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer)
• Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
• Advanced coding proficiency in SQL & SAS, with strong applied experience in Python and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation
• Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
• Familiarity with Senior Markets lines of business (MAPD, DSNP, Medicare Supplement, Medi-Cal) and CMS MARx regulatory data structures (MMR, DTRR, BEQ, etc.)
• Familiarity with PEGA, Salesforce and similar enterprise CRM/outreach applications
• Proficiency in interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities

Requirements

• Requires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer)
• Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
• Advanced coding proficiency in SQL & SAS, with strong applied experience in Python and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation
• Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
• Familiarity with Senior Markets lines of business (MAPD, DSNP, Medicare Supplement, Medi-Cal) and CMS MARx regulatory data structures (MMR, DTRR, BEQ, etc.)
• Familiarity with PEGA, Salesforce and similar enterprise CRM/outreach applications

Benefits

Blue Shield of California offers a comprehensive benefits package including health insurance, dental, vision, retirement plans, and paid time off.

Pay

$123,090.00 to $184,800.00

Schedule

Full time