Principal Risk Adjustment Healthcare Analyst

The Impact You Will Have
Blue Cross and Blue Shield of Minnesota is hiring a Principal Healthcare Analyst on our Risk Adjustment team in Eagan, MN. The Principal Healthcare Analyst - Risk Adjustment is responsible for leading analytical insights to develop and implement strategic business solutions through research, auditing, and data analysis. This role leverages deep expertise in Risk Adjustment and healthcare data-primarily Medicare Advantage, Medicaid, and ACA Commercial-identifying trends and communicating insights to senior stakeholders across the enterprise.

The ideal candidate will have experience in Risk Adjustment methodologies, clinical coding, and healthcare programs (Medicare Advantage, Medicaid, ACA Commercial), as well as proficiency in SQL, Power BI, and presenting findings to diverse audiences. Acting as a Content Expert and Business Lead, this position drives strategic initiatives and influences decision-making at Blue Cross Blue Shield of Minnesota.

Success in this role requires a combination of industry knowledge, programming and data skills, and strong statistical and analytical capabilities. The Principal Healthcare Analyst will make significant contributions that shape strategic decisions and improve organizational performance.

Your Responsibilities

• Uses databases for analysis and dissemination of information.

• Performs complex analysis of data.

• Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.

• Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.

• Leads teams to develop analytic approaches, measurement plans, data analysis, and report results on health care utilization, expenditures, outcomes, and benchmarks.

• Initiates actions to discover new analyses that will contribute to the strategic needs of Blue Cross Blue Shield of Minnesota.

• Works with leadership to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.

• Helps drive the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.

• Represents the division on corporate projects and may have leadership roles on these teams.

• Independently manages issues that may arise on multiple tasks or projects with limited or no management involvement.

• Acts as a resource and/or mentor for other members of the department and company on business issues and may be responsible for training and guidance of other employees.

• Formulates strategic recommendations and present findings to management and external clients.

• Serves as an analytic consultant who can explain complex measurement or analysis techniques and results in layman's terms.

Required Skills and Experience

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• 5 years experience analyzing and modeling data involving outcomes and utilization, using various statistical software and computer programming (SQL and Power BI).

• Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.

• Demonstrated ability to design, evaluate and interpret complex data sets.

• Demonstrated ability to handle multiple tasks with competing priorities.

• Demonstrated analytic and problems solving skills.

• Excellent written and verbal communication skills, with the ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.

• Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.

• Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/clinical.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• At least 3 to 5 years of experience working in healthcare analytics with a focus on Risk Adjustment is strongly preferred.

• Experience supporting multiple payers or lines of business (Medicare Advantage, Medicaid, ACA Commercial).

• Familiarity with clinical coding (ICD-10-CM) and revenue cycles.

• Design, maintain and automate Power BI / SQL based dashboards and standard reports for leadership.

• Experience developing and maintaining dashboards (via Power BI) showing risk adjustment activities performance across multiple lines of business.

• Provide ad-hoc analysis to support business cases, audit responses, and reporting.

• Knowledge of managed care and healthcare claims preferred.

• Bachelor's degree.