Remote Senior ACA Risk Insights Lead

Blue Cross and Blue Shield of North Carolina; Durham (NC); Hybrid; USD 98,000 - 157,000; Full time

Benefits offered by this job

Health benefits

Parental leave

401(k) match

Job summary

Blue Cross NC seeks a Senior Insights Analyst to provide advanced analytics for ACA risk adjustment. You will access, validate, and analyze complex healthcare data, drive RAF score production, and explain regulatory analytics to leadership.

You will partner with Actuarial, governance, and operations to improve processes, controls, and documentation while ensuring data security and privacy.

Qualifications

• Bachelor's degree or advanced degree required; 5+ years in related field, or 7+ years if no degree.
• Advanced SQL skills and Python or comparable tools preferred.
• Experience validating risk scores, reconciling results, and root-cause analysis.

Responsibilities

• Provide advanced analytical support for ACA risk adjustment, including data collection, modeling, forecasting, validation, and reconciliation.
• Develop, analyze, and interpret complex data for internal and external customers with clear business insights.
• Support model implementation, testing, validation, and RAF score production across systems.
• Present findings and recommendations to technical and non-technical audiences; collaborate with Actuarial, regulatory, and operations teams.

Skills

SQL

Python

Data analysis

Stakeholder communication

Education

Bachelor's degree or advanced degree

Tools

Edge data platform

Job description

Blue Cross NC seeks a Senior Insights Analyst to provide advanced analytics for ACA risk adjustment. You will access, validate, and analyze complex healthcare data, drive RAF score production, and explain regulatory analytics to leadership.

You will partner with Actuarial, governance, and operations to improve processes, controls, and documentation while ensuring data security and privacy.