Senior Population Risk Performance Analyst (Value-Based Care)

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

Benefits offered by this job

Annual incentive bonus

401(k) with employer match

Paid Time Off (PTO)

Competitive health benefits

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Sr. Population Risk Performance Analyst to apply population risk models for value-based care performance measurement and financial normalization across attributed member populations.

You will operationalize CMS-HCC and Milliman methodologies, support risk-normalized total cost of care and quality metrics, and collaborate with actuarial, finance, and data teams to ensure accurate performance outcomes.

Qualifications

• Bachelor's degree or higher in healthcare administration, business, public health, or related field.
• 5+ years of experience in related field; 7+ years if no degree.
• Experience with population risk models (CMS-HCC, Milliman) or equivalent.
• Experience analyzing healthcare claims and eligibility datasets.
• Strong SQL and analytical data experience.

Responsibilities

• Apply population risk and actuarial models to normalize performance measurement across value-based care programs.
• Operationalize CMS-HCC and Milliman methodologies for performance evaluation and financial measurement.
• Support development and maintenance of risk-normalized total cost of care and quality metrics.
• Validate methodologies used in shared savings, downside risk, and APMs.
• Collaborate with actuarial, finance, and analytics teams to align modeling with contractual logic.

Skills

Analytical thinking

SQL proficiency

Data analysis

Data mining / data science

Trends analysis

Education

Bachelor's degree or higher

Advanced degree preferred

Job description

Job Description This role is responsible for providing advanced analytical and modeling expertise supporting value-based care performance measurement and population risk normalization. The Sr. Population Risk Performance Analyst applies population risk models to attributed member populations to ensure accurate, consistent, and defensible financial and quality performance measurement across value-based care programs. The role operationalizes risk and actuarial modeling methodologies to support total cost of care evaluation, performance reconciliation, forecasting, and provider settlement processes. This position partners closely with actuarial, finance, clinical economics, and value-based care operations teams to ensure performance outcomes appropriately reflect population acuity and contractual measurement intent. This role is distinct from coding-based risk adjustment functions and focuses on performance measurement methodology and financial normalization.

What You Will Do

• Apply population risk and actuarial models to normalize performance measurement across value-based care programs.
• Operationalize CMS-HCC, Milliman, and comparable population risk methodologies for performance evaluation and financial measurement.
• Support development and maintenance of risk-normalized total cost of care and quality performance metrics.
• Validate performance measurement methodologies used in shared savings, downside risk, and alternative payment models.
• Analyze population risk movement and evaluate impacts on program financial performance and provider outcomes.
• Partner with actuarial and finance teams to align modeling assumptions with contractual measurement logic.
• Identify and investigate performance variances driven by population acuity, attribution changes, coding variation, or data completeness.
• Support performance year reconciliation, settlement calculations, and financial exposure analysis.
• Define and document measurement methodologies, assumptions, and model governance controls.
• Collaborate with analytics and data engineering teams to integrate risk modeling logic into reporting and measurement pipelines.
• Provide analytical expertise supporting provider performance reviews and measurement inquiries.
• Translate complex modeling outcomes into clear insights for operational and executive stakeholders.
• Ensure consistency and repeatability of population measurement processes across programs and performance periods.
• Serve as subject matter expert for population risk interpretation supporting value-based care strategy and operations.

What You Bring

• Bachelor's degree or advanced degree in healthcare administration, business, public health, or related field.
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.
• Demonstrated experience working with population risk models including CMS-HCC and Milliman methodologies (or equivalent).
• Experience analyzing healthcare claims and eligibility datasets.
• Strong SQL and analytical data experience.

Preferred Qualifications

• Experience supporting Medicare Advantage and Commercial value-based care programs.
• Familiarity with total cost of care measurement and shared savings models.
• Experience collaborating with actuarial, finance, or clinical economics teams.
• Knowledge of attribution methodologies and population performance analytics.
• Experience supporting provider settlement or reconciliation processes.

Skills

• Analytical Analysis
• Data Analysis
• Data Analysis Reporting
• Data Engineering
• Data Governance
• Data MiningData Science
• Identifying Trends
• Trend Analysis

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance.

$98,092.00 - $156,947.00

About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we’re leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well‑being of North Carolinians. Blue Cross NC is a fully taxed, not‑for‑profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award‑winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.