Medical Informatics Analyst, Consultant

Blue Shield of CA; Lodi (CA); Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California is seeking an AI & Analytics professional to bridge business needs and advanced analytics within the AI & Analytics team. You will lead analytic initiatives across IFP, Actuarial, HQA, Network Operations, and Finance, translating complex problems into scalable data solutions.

The role requires deep healthcare analytics experience, strong SQL/Python/SAS skills, and familiarity with cloud data stacks. The hybrid model expects in-office collaboration two days per week.

Qualifications

• Bachelor's degree or equivalent with 4 years of experience; Master’s preferred.
• 7 years of healthcare analytics experience (cost, quality, utilization, and/or outcomes).
• 5+ years advanced experience with Medical Claims, Membership and Provider data architectures.
• Advanced SQL & Python; SAS experience; knowledge of cloud-native data stacks (Snowflake, Databricks, RDBMS) for pipeline automation.
• Familiarity with AI tooling (e.g., GitHub Copilot) or willingness to adopt AI tooling.

Responsibilities

• Partner with AI & Analytics to support IFP and growth objectives across multiple stakeholders.
• Translate complex business problems into structured analytical approaches and design analytical tools and pipelines.
• Collaborate with cross-functional teams (IFP, Actuarial, HQA, Network Operations, Finance) to achieve growth-related goals.

Skills

SQL

Python

SAS

Data Modeling

Education

Bachelor's degree or equivalent

Master's degree preferred

Tools

Snowflake

Databricks

RDBMS

PEGA

Salesforce

Job description

Your Role

The AI & Analytics (AI&A) team sits within the enterprise Growth organization, specifically aligned to the Risk Adjustment vertical. While situated within Risk Adjustment, this is strictly an advanced Medical Informatics and data architecture role. The Consultant will serve as a critical semantic bridge and analytical lead supporting the Individual & Family Plan (IFP) Line of Business under the Government Markets Organization.

Reporting to the Sr Manager of Medical Informatics, this role is responsible for acting as an AI & Analytics partner to key leaders and cross-functional stakeholders across IFP, Actuarial, HQA, Network Operations, and Finance to achieve their Growth-related business objectives. The successful candidate will act as "two-in-a-box" collaborator to share LOB Membership Retention & Growth goals, and Covered CA regulatory reporting, translate complex business problems into structured analytical approaches, design smart analytical tools, and leverage internal data structures to uncover CoHC optimization and member acquisition opportunities.

Your Knowledge and Experience

• Requires a bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree . Master's degree preferred
• Requires 7 years of relevant experience delivering healthcare analytics(cost, quality, utilization, and/or outcomes)
• Requires 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures
• Requires advanced coding proficiency in SQL & Python, with strong applied experience in SAS and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation
• Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
• Requires deep domain fluency with IFP lines of business (On Exchange, Off Exchange, Covered CA Small Business) and standard enrollment and claims data structures
• Requires high degree of fluency with PEGA, Salesforce and similar enterprise CRM/outreach applications
• Requires high degree of proficiency with interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.