Senior Data Risk Adjustment Analyst (Remote)

Purpose

Support the Health Services Risk Adjustment team through advanced analytics, reporting, and data-driven insights that enhance program performance and operational effectiveness. Responsible for developing and maintaining trusted data assets, producing meaningful analyses and reporting, and partnering with clinical, operational, financial, and technology teams to support Risk Adjustment initiatives across the organization.

Essential Functions

• Perform advanced data exploration, analysis, and solution development using programming languages and analytical tools to support Risk Adjustment initiatives.
• Leverage expertise across complex healthcare data structures including claims, encounters, provider, member, and risk adjustment data sources to identify trends, coding opportunities, and program improvement strategies.
• Collect, analyze, and interpret Risk Adjustment data to generate actionable insights and recommendations that improve risk score accuracy, program performance, financial outcomes, and regulatory compliance.
• Research, validate, and analyze data flow across operational and analytical ecosystems to ensure the integrity, completeness, and traceability of Risk Adjustment data used for reporting, forecasting, reconciliations, and regulatory submissions.
• Serve as a subject matter resource for Risk Adjustment analytics, supporting stakeholders with data inquiries, business questions, and issue resolution related to risk scores, coding initiatives, program performance, and regulatory reporting.
• Lead the design, development, testing, validation, and delivery of analytical solutions, dashboards, and reporting that support Risk Adjustment strategy, targeting initiatives, operational decision-making, and program effectiveness measurement.
• Partner with business and technical stakeholders to gather requirements and deliver data-driven solutions supporting Medicare, Medicaid, and ACA Risk Adjustment programs.
• Develop and maintain technical documentation, business requirements, data specifications, and process documentation consistent with organizational standards.

Qualifications

• Bachelor's Degree in Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• 5 years experience in an analytical/quantitative role.
• Experience in Healthcare Industry (preferred).
• Hands-on experience with Big Data/NoSQL Platforms with experience delivering production projects at scale (preferred).
• Proficiency with SQL, Power Bi, Fabric, Python, and/or SSMS (preferred).

Knowledge, Skills, and Abilities

• Quantitative, analytical and problem-solving skills.
• Knowledge and understanding of analytical tools, languages, applications, platforms.
• Excellent communication skills both written and verbal.
• Ability to learn quickly and take direction.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Pay

Salary Range: $87,264 - $173,316. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.