Risk Adjustment Health Data Analyst

The Risk Adjustment Health Data Analyst role at Blue Cross and Blue Shield of Nebraska (BCBSNE) sits within the Healthcare Analytics team, focusing on evaluating program performance and identifying opportunities to strengthen risk adjustment strategies. This position is based in Texas with a hybrid work arrangement, enabling collaboration across cross-functional teams as they analyze healthcare data to inform operational decisions and strategic interventions. The role combines reporting, forecasting, and actionable insights to support financial and clinical impact assessments within Risk Adjustment programs.

Responsibilities

• 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.

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.

Technologies

• SQL
• Microsoft Azure DataBricks
• Excel
• R
• Python
• PowerBI
• Tableau

Strongest candidates will also possess

• Proficiency working within an environment that utilizes Agile and/or Project Management techniques.
• Successful experience with creating analytic models based on data trends, program ROI, data Quality Analysis, etc.
• The translation of data findings into informative reports and visual outputs trusted by stakeholders to make business decisions.
• Experience designing or building self-service content.
• Advanced SQL knowledge.
• Understanding of Health Insurance Operations knowledge including claims, enrollment, payment mechanisms, care management, employer reporting and the ability to stay current on healthcare industry knowledge.
• Strong knowledge of the MA risk adjustment models, concepts, payment methodologies and submission requirements.
• Ability to use advanced-level calculations in the transforming of data sets into usable data.
• Ideal candidate would have experience using data manipulation tools such as R and/or Python.
• Proficiency of visualization best practices as well as Proficiency with visualization tools such as PowerBI and/or Tableau.
• Experience with Microsoft Azure DataBricks.
• Ability to translate technical requirements into business deliverables.
• Skilled in navigating relationships with external partners such as vendors, providers, groups, brokers, etc.
• Master’s Degree in Business, Analytics, Information Technology or a Related Field.