Risk Adjustment Consulting, Associate

Blue Shield of California; California (MO); Hybrid; USD 45,000 - 63,000; Full time

Job summary

Blue Shield of California is seeking a candidate to grow in decision analytics, building skills in data analysis, reporting, and program updates. The role emphasizes collaboration on cross-functional teams to deliver new or existing internal and external programs and products, with in-office hybrid scheduling and a focus on accuracy and process discipline.

The position requires a math/statistics/CS background, strong data skills, and an eye for detail.

Qualifications

• Requires a bachelor’s degree in mathematics, statistics, computer science, or a related field.
• Requires basic analytic and data skills to support reporting, validation, and documentation tasks.
• Requires attention to detail to follow defined processes and quality checks for assigned work.
• Risk Adjustment experience preferred.
• Project Management experience preferred.

Responsibilities

• Actively learning the core principles of decision analytics with knowledge of the analytic tools and techniques that are used to acquire and analyze data for reporting and decision making
• Understand, update, and run programs that applies to decision analytic techniques
• Understand claim, premium, membership and/or risk score assignment data at a basic level
• Compile and categorize data, documenting and verifying the factors used in computations such as those used in premiums, benefits, member risk data and score submissions and establishing rating and pricing levels
• Participate in the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products

Skills

Analytic thinking

Data skills

Attention to detail

Project management

Risk adjustment experience

Education

Bachelor's in mathematics, statistics, CS, or related field

Job description

• Actively learning the core principles of decision analytics with knowledge of the analytic tools and techniques that are used to acquire and analyze data for reporting and decision making
• Understand, update, and run programs that applies to decision analytic techniques
• Understand claim, premium, membership and/or risk score assignment data at a basic level
• Compile and categorize data, documenting and verifying the factors used in computations such as those used in premiums, benefits, member risk data and score submissions and establishing rating and pricing levels
• Participate in the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products

Job Description

Your Work

• Actively learning the core principles of decision analytics with knowledge of the analytic tools and techniques that are used to acquire and analyze data for reporting and decision making
• Understand, update, and run programs that applies to decision analytic techniques
• Understand claim, premium, membership and/or risk score assignment data at a basic level
• Compile and categorize data, documenting and verifying the factors used in computations such as those used in premiums, benefits, member risk data and score submissions and establishing rating and pricing levels
• Participate in the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products

Qualifications

Your Knowledge and Experience

• Requires a bachelor’s degree in mathematics, statistics, computer science, or a related field
• Requires basic analytic and data skills to support reporting, validation, and documentation tasks
• Requires attention to detail to follow defined processes and quality checks for assigned work
• Risk Adjustment experience preferred
• Project Management experience preferred

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.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

Job Identification : 20261793

Job Category : Actuarial Services

Posting Date : 2026-09-15T19:27:49+00:00

Job Schedule : Full time

Locations :

Oakland, CA, United States

CA, United States

Pay Range for California : $33.04 to $46.25

Pay Range for Bay Area : $37.24 to $52.14

Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No