Senior ACA Risk Analytics Lead

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

Benefits offered by this job

Health benefits

401k matching

Parental leave

Tuition reimbursement

Job summary

Blue Cross NC seeks a Senior Insights Analyst to provide advanced analytical support for ACA risk adjustment, including data collection, model implementation, forecasting, validation, reporting, and financial reconciliation.

You will partner with Actuarial, regulatory submission, and operations teams, ensuring robust analyses, documentation, and timely delivery within a Hybrid-Flex environment.

Qualifications

• Bachelor's degree or advanced degree with 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.
• Experience with ACA risk adjustment analytics preferred.

Responsibilities

• Use analytical and reporting tools, including SQL, Python, and other approved platforms, to access, investigate, validate, and analyze complex healthcare data.
• Develop, analyze, report, and interpret complex data for ongoing activities and projects while ensuring outputs are accurate, documented, and available within established deadlines.
• Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production.
• Perform in-depth trend, variance, and root-cause analysis to explain changes in risk scores, transfer estimates, regulatory submission results, and provider settlement outputs.
• Reconcile outputs across analytical processes and source systems, identify discrepancies, and coordinate issue resolution with business, technical, and operational partners.

Skills

SQL

Python

Data analysis

Education

Bachelor's degree

7+ years experience in related field

Job description

Blue Cross NC seeks a Senior Insights Analyst to provide advanced analytical support for ACA risk adjustment, including data collection, model implementation, forecasting, validation, reporting, and financial reconciliation.

You will partner with Actuarial, regulatory submission, and operations teams, ensuring robust analyses, documentation, and timely delivery within a Hybrid-Flex environment.