Providence Health Plan is seeking a Risk Adjustment Analytics Principal to develop and implement tools, metrics, and reports that support the organization’s risk management and financial performance strategies.
Requirements
- Experience with advanced analytics, reporting tools, and data visualization techniques.
- Deep understanding of healthcare risk adjustment processes, models, and regulations.
- Proven experience in healthcare data analysis, risk adjustment, or related fields.
- Strong project management skills with the ability to lead complex initiatives.
- Preferred: Master’s Degree in a related field and formal training in CQI/TQM and statistical process control methodologies.
- Healthcare organization or health insurer experience is highly desirable.
- Bachelor’s Degree in Statistics, Mathematics, Actuarial Science, Economics, Engineering/Physics, Accounting, Computer Science, or a related highly quantitative field.
Responsibilities
- Collaborate with Risk Adjustment leadership and stakeholders to establish analytics priorities, define project scope, and ensure timely delivery of reports and tools.
- Develop and maintain advanced analytical models and reports to support risk adjustment strategies and performance measurement.
- Lead data collection, validation, and analysis efforts across multiple systems and sources to ensure accuracy and completeness.
- Provide expert guidance on risk adjustment methodologies, expected outcomes, and regulatory requirements.
- Organize and present complex data analyses to senior leadership, translating technical findings into actionable insights.
- Mentor and develop junior analysts and team members, fostering a culture of continuous learning and technical excellence.
- Build and maintain relationships with internal departments such as Actuarial, Compliance, Finance, and IS, as well as external agencies like CMS and state regulators.
Other
- Excellent communication skills to effectively collaborate with cross-functional teams and external agencies.
- Minimum of 10 years of experience in data analysis at a decision-making level, or High School Education with at least 12 years of relevant experience.
- Bachelor’s Degree in Statistics, Mathematics, Actuarial Science, Economics, Engineering/Physics, Accounting, Computer Science, or a related highly quantitative field.
- Preferred: Master’s Degree in a related field and formal training in CQI/TQM and statistical process control methodologies.
- Healthcare organization or health insurer experience is highly desirable.
