CareFirst BlueCross BlueShield is looking to improve its risk adjustment processes by enhancing data integrity, monitoring key performance indicators, and providing actionable insights to inform operational decisions.
Requirements
- Proficiency in SQL, Power BI, Excel, and PowerPoint, with experience presenting to stakeholders.
- Hands-on experience with Big Data/NoSQL platforms and delivering large-scale production projects.
- Knowledge of claims data, data warehouses, and healthcare data ecosystems.
- Deep understanding of risk adjustment, preferably in the healthcare industry, including clinical, submission cycle, and financial aspects.
- Familiarity with tools such as Fabric and Alteryx is a plus.
- Demonstrating advanced knowledge of database structures.
- Experience presenting to stakeholders.
Responsibilities
- Engage in comprehensive data exploration using various programming languages, demonstrating advanced knowledge of database structures.
- Collect, analyze, and interpret healthcare data to generate meaningful insights and develop strategic recommendations.
- Research and analyze data flow across complex operational and analytical platforms, ensuring data accuracy and integrity.
- Gather and document business and technical requirements from stakeholders to develop data-driven solutions.
- Design, develop, validate, and deliver data reports and dashboards that support business decision-making processes.
- Lead efforts in the development of technical documentation, ensuring adherence to professional standards.
- Monitor and report on risk adjustment KPIs, providing insights for both prospective and retrospective operational improvements.
Other
- Minimum of 8 years of progressive experience in analytical or quantitative roles.
- Strong project management skills with the ability to handle multiple stakeholders and deadlines.
- Excellent communication skills, both written and verbal, with the ability to translate complex data into clear insights.
- Ability to learn quickly, take direction, and provide positive customer service.
- Mentor and guide team members, fostering a collaborative and knowledgeable team environment.
