Risk Adjustment Healthcare Analyst III

Medica; Madison (WI); On-site; USD 91,000 - 123,000; Full time

Job summary

Medica, a nonprofit health plan, seeks a senior Risk Adjustment Healthcare Analyst in Madison, WI. You will translate claims data into actionable insights, own analytics deliverables, and collaborate with actuarial, finance, clinical, and operations teams to support the riskAdjustment strategy.

You will monitor RAF scores, HCC coding accuracy, and regulatory compliance while building dashboards in Tableau/Power BI for diverse audiences.

Qualifications

• Bachelor's degree in Healthcare Analytics, Data Analytics, Finance, Economics, Healthcare Administration, or a related field. Master's degree preferred.
• Minimum of 3 years of experience in healthcare analytics, reporting, or data analysis.
• Experience supporting risk adjustment, Medicare Advantage, or CMS-related programs strongly preferred.

Responsibilities

• Develop, maintain, and enhance complex risk adjustment reporting and analytic solutions, including HCC coding accuracy, RAF score performance, and financial impact analysis.
• Collaborate closely with actuarial, finance, clinical, quality, and operational partners to support data-driven decision-making.
• Ensure the integrity, consistency, and reliability of risk adjustment data through validation and reconciliation processes.
• Monitor and analyze key risk adjustment performance indicators; identify trends, variances, and anomalies and communicate findings to stakeholders.
• Design and deliver dashboards and visualizations (Tableau, Power BI) that communicate complex findings to technical and non-technical audiences.
• Maintain knowledge of CMS risk adjustment guidelines and model changes to ensure regulatory compliance.
• Identify opportunities to improve analytic processes and contribute to standardization and documentation.

Skills

SQL

Python

SAS

R

Data analysis

Communication

Education

Bachelor's degree in Healthcare Analytics or related field

Master's degree preferred

Tools

Tableau

Power BI

Job description

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Risk Adjustment Healthcare Analyst (P3) is a senior-level individual contributor responsible for delivering complex, high-impact analytics and reporting that supports the organization's Risk Adjustment strategy. This role translates healthcare and claims data into actionable insights that inform financial performance, coding accuracy, and regulatory compliance.

Operating with minimal supervision, the analyst independently owns assigned analytics and reporting deliverables and serves as a trusted analytical resource to cross-functional partners including actuarial, finance, clinical, and operational teams. The role requires strong applied analytics expertise, solid understanding of CMS risk adjustment methodologies, and the ability to clearly communicate insights to diverse audiences.

Key Accountabilities

• Risk Adjustment Analytics & Reporting
  Independently develop, maintain, and enhance complex risk adjustment reporting and analytic solutions, including HCC coding accuracy, RAF score performance, and financial impact analysis. Ensure outputs are accurate, timely, and aligned with business needs.
• Cross-Functional Partnership
  Collaborate closely with actuarial, finance, clinical, quality, and operational partners to support data-driven decision-making. Serve as an analytical resource by explaining results, assumptions, and implications of risk adjustment analytics.
• Data Quality & Validation
  Ensure the integrity, consistency, and reliability of risk adjustment data through established validation and reconciliation processes. Identify data quality issues, conduct root-cause analysis, and recommend corrective actions.
• Performance Monitoring & Insight Generation
  Monitor and analyze key risk adjustment performance indicators. Identify trends, variances, and anomalies, and proactively communicate findings and implications to stakeholders.
• Data Visualization & Communication
  Design and deliver dashboards and visualizations (e.g., Tableau, Power BI) that clearly communicate complex analytical findings to technical and non-technical audiences.
• Regulatory & Methodology Awareness
  Maintain working knowledge of CMS risk adjustment guidelines and model changes. Ensure analytic outputs and reporting methodologies align with current regulatory requirements.
• Process Improvement
  Identify opportunities to improve analytic processes, reporting efficiency, and data usability. Contribute to standardization and documentation of analytic approaches within the team.

Required Qualifications

• Education
  Bachelor's degree in Healthcare Analytics, Data Analytics, Finance, Economics, Healthcare Administration, or a related field. Master's degree preferred.
• Experience
  Minimum of 3 years of experience in healthcare analytics, reporting, or data analysis. Experience supporting risk adjustment, Medicare Advantage, or CMS-related programs strongly preferred.

Technical Skills

• Understanding of HHS/CMS risk adjustment methodologies,
• Proficiency in SQL and analytic tools such as Python, SAS, R, or similar

• Analytical Skills
  Strong ability to analyze complex datasets, interpret results, and translate findings into clear, actionable insights.
• Communication & Collaboration
  Demonstrated ability to communicate analytical findings effectively and collaborate with cross-functional partners.
• Attention to Detail
  High level of accuracy, organization, and accountability, with a strong commitment to data quality.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $90,500 - $155,200. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $90,500 - $122,835. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.