Blue Cross Blue Shield

Senior Data Analyst/ Systems Analysis | Technical

Posted by: Blue Cross Blue Shield of Massachusetts
Hingham, | Senior Level | Brand Side

Ready to help us transform healthcare? Bring your true colors to blue. 

The Lead Data Analyst provides oversight, direction and analytical support to the Risk Adjustment Team including all other analyst positions. In this role, the Senior Analyst is responsible for development and maintenance of applications and tools to support the risk adjustment department, working closely with vendors on results, logic, and analytics to perform root cause analysis, make recommendations for improvement, and quantify results.

This position will require effective interpersonal skills and communication skills. The role requires frequent interaction with directors and managers in Health Care Coordination, Product Management, Provider Contracting, Legal and IT.

Key Accountabilities:

  • Support the Risk Adjustment department and vendor activities providing technical solutions, analytics, assessments of vendor results and critical reporting.
  • Serve as the modeler who can develop and understand conceptual and logical business models which will be used to generate physical models and define solution approaches by working closely with the architecture/solution leads.
  • Manage relationships with risk adjustment vendors ensuring implementation and operational issues are addressed timely, and collaborating with other departments when necessary.
  • Provide timely analysis of risk adjustment outcomes and participate in the development of new risk adjustment opportunities.
  • Support initiatives related to informing program direction, program results, key analytics and actionable reports to physician groups
  • Develop and manage reporting of risk adjustment department dashboard, metrics and program results.
  • Provide analytics and reports to constituent departments to inform financial plans, forecasts and annual bids.
  • Perform other related projects and duties as assigned.
  • Collect, analyze and synthesize data; develop information and reporting to guide business decision making for risk adjustment activities and revenue optimization strategies.
  • Design, build and enhance database systems for complex high level reporting requirements
  • Critically review results of analytics to make recommendations on process improvements, vendor remediation, changes to strategic approaches, etc
  • Monitor related guidance and keep relevant stakeholders informed
  • Partner closely with internal business partners, directors and managers, such as Health Care Coordination, Product Management, Provider Contracting, Legal and IT regarding the results of multiple risk adjustment initiatives.
  • Interact with all departments, maintain effective team relationships and share best practices with Operations leaders and associates.
  • Demonstrate loyalty, integrity and professionalism.
  • Foster a team-based environment by participating in projects and activities that support the goals of the team.
  • Develop a strong analytic team, encouraging career and developmental growth, and provide leadership support to analysts and others in Risk Adjustment department.

Experience and Qualifications:

  • Knowledge of risk adjustment methodology preferred.
  • Requires demonstrated analytical and decision making skills
  • Proficiency in Visual Basic required. Must be proficient with MS Access.
  • Extensive experience with SQL required.
  • Demonstrated ability to handle multiple tasks simultaneously
  • Experience participating in cross-functional teams.
  • Excellent oral and written communication skills evidenced by the ability to present information effectively.
  • Creative problem solving skills
  • Exceptional analytical skills and technical expertise
  • Ability to effectively plan and facilitate meetings and workgroups.
  • High degree of initiative and professionalism; ability to effectively interact with all levels of an organization.

Education/Relevant Experience:

  • Bachelor’s degree or equivalent work experience required.
  • 5-10+ years of experience in systems analysis or programming with emphasis in applications and systems architectural design and development, database and middleware technologies is preferred.
  • Experience in health insurance operations and industry knowledge of risk adjustment/Medicare plans is preferred.



Time Type
Full time

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