Blue Shield of CA
Your Role
The Risk Adjustment Retrospective Analytics team focuses on delivering complete and accurate analytics for Prospective and Retrospective suspecting, financial impact calculations, and data submission. The Risk Adjustment Analyst, Experienced will report to the Manager of Risk Adjustment Analytics. In this role you will develop and refine Risk Adjustment Suspecting logic, quantify the financial impact of the Risk Adjustment programs, and support complete and accurate data submission for both Medicare Advantage and ACA Chart Review Programs.
Your Knowledge and Experience
Requires a bachelor's degree in mathematics, statistics, computer science or related field or equivalent business experience
Requires at least 3 years of professional experience in healthcare preferably in risk adjustment or actuarial
Requires practical knowledge of job area obtained through professional experience and advanced education
Requires proficiency with MS Office, including Excel, Word, PowerPoint
Familiarity with SQL, SAS, R, Python or other data analysis tools strongly preferred
Prior exposure to claims data, membership data, premium data, and risk score assignment processes strongly preferred
Excellent communication and presentation skills with the ability to translate complex information to cross‑functional teams (e.g., vendor management, product, finance, compliance)
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Your Knowledge and Experience
Requires a bachelor's degree in mathematics, statistics, computer science or related field or equivalent business experience
Requires at least 3 years of professional experience in healthcare preferably in risk adjustment or actuarial
Requires practical knowledge of job area obtained through professional experience and advanced education
Requires proficiency with MS Office, including Excel, Word, PowerPoint
Familiarity with SQL, SAS, R, Python or other data analysis tools strongly preferred
Prior exposure to claims data, membership data, premium data, and risk score assignment processes strongly preferred
Excellent communication and presentation skills with the ability to translate complex information to cross‑functional teams (e.g., vendor management, product, finance, compliance)
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