Senior Risk Adjustment Analyst - St. Luke's Health Plan - 157876

Overview

This role serves as a Risk Adjustment Analyst and a strategic partner to the business segments within the health plan. The position leads the development of business processes and delivers insights through health insurance data analysis, working closely with cross-functional stakeholders.

A specific focus of this role is applying risk adjustment knowledge and technical analytics experience for QHP/ACA and Medicare Advantage.

Responsibilities

• Analyze and interpret health insurance data, including eligibility, premium, medical, and pharmacy claims data.
• Serve as a subject matter expert on available health insurance data and apply it to identify, escalate, and resolve operational issues.
• Understand and interpret operational processes and business context to translate technical, clinical, financial, and operational problems into analysis that supports decision-making.
• Use expertise in health insurance regulatory programs and requirements, including HEDIS/quality programs, risk adjustment, and utilization management.
• Perform high-value health insurance data analysis, interpret key business metrics, and present insights to business leaders and key stakeholders for operational planning.
• Challenge and support business decisions using analytical rigor, insights, and judgment.
• Partner with internal Data & Analytics to define scope, requirements, data validation, and provide prioritization input.
• Collaborate with vendors and external parties to develop data requirements and ensure appropriate data validation and integrity.
• Contribute to data management and data governance by helping define data policies and standards to support high-quality data and analytics.
• Build and maintain functional, analytical, and technical acumen, and develop strong partnerships with internal customers and cross-functional teams.
• Handle independent judgment and decision-making for all but the most complex assignments, and serve as a subject matter expert to colleagues.
• Lead special projects and participate in workgroups and teams as assigned.
• Complete other duties and responsibilities as assigned.

Requirements

• Bachelor’s degree or experience in lieu of degree
• Six (6) years of relevant experience

Preferred Qualifications

• Experience in QHP/ACA and Medicare Advantage Risk Adjustment Analytics
• Experience in MA Encounter Data Submission
• Experience in EDGE Server Data Submission
• Strong skills in SQL
• Knowledge of HEDIS

Compensation & Benefits

• Competitive salary
• Retirement plans
• Robust benefits package, including medical, dental, and vision
• Financial and physical wellness options, such as:
  • On-site massages
  • On-site counseling via an Employee Assistance Program
  • Access to the Personify Health Wellness tool
• Formal training and career development opportunities

Location

• Fully remote position
• Must reside in Idaho, Utah, Oregon, or Arizona to be considered