Risk Adjustment Health Data Analyst

Nebraska Blue Cross and Blue Shield

Job Overview

Location

Remote flexibility for candidates in FL, IA, KS, MN, MO, NE, ND, or TX

Job Type

Full-time

Full Job Description

📋 Description

• Analyze healthcare claims, pharmacy, lab, and Risk Adjustment submissions data to evaluate intervention and program performance.
• Develop, maintain, and present reports that measure intervention ROI, incremental conditions captured, risk score impact, revenue impact, and other key Risk Adjustment performance metrics.
• Partner with internal teams to support Risk Adjustment analytics needs, intervention planning, reporting enhancements, and issue resolution.
• Stay current on healthcare analytics, Risk Adjustment trends, tools, methodologies, and regulatory considerations; recommend process or reporting improvements where appropriate.
• Provide analytic solutions on ad-hoc requests with little oversight by senior analysts.
• Develop reporting, forecasts, and actionable recommendations that inform Risk Adjustment strategy, intervention planning, and operational decision-making.
• Develop, maintain, and present reports that measure intervention ROI, incremental conditions captured, risk score impact, revenue impact, and other key Risk Adjustment performance metrics.

🎯 Requirements

• Bachelor’s degree or equivalent
• 3+ years’ experience in data or statistical analysis, or experience with managing and analyzing data for Government programs (Medicare Advantage, Commercial ACA) including experience working with healthcare-related data, such as claims, encounters, provider data, CMS files, EDGE response files, or similar datasets.
• Proficiency in SQL and data analytics.
• Experience with Microsoft Azure DataBricks.
• Advanced Excel skills.
• Strong analytic skills to construct impactful findings from the extraction, manipulation and understanding of various types of data.
• Successful experience working in a cross-functional environment.
• Experience effectively communicating with stakeholder groups.

🏖️ Benefits

• Competitive salary
• Comprehensive benefits package
• Opportunities for professional growth and development
• Collaborative and dynamic work environment
• Flexible work arrangements
• Recognition and rewards for outstanding performance

Skills & Technologies

Python

Azure

Remote

Degree Required

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Nebraska Blue Cross and Blue Shield

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About Nebraska Blue Cross and Blue Shield

Nebraska Blue Cross and Blue Shield is a member-owned nonprofit health insurer headquartered in Omaha, providing medical, dental, vision, pharmacy, and supplemental coverage to individuals, families, and employers statewide. Founded in 1939, the company administers self-funded plans, Medicare Advantage, and Medicaid products, operating a statewide provider network of hospitals, physicians, and specialists. It also offers health-management programs, wellness incentives, and digital tools to improve care quality and affordability for more than 750,000 members.

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