Senior Population Risk & Performance Lead

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

Job summary

Blue Cross NC in Chapel Hill, NC seeks a Sr. Population Risk Performance Analyst to apply population risk models to attributed member populations and ensure defensible financial and quality performance across value-based care programs.

You will operationalize risk methodologies, support total cost of care evaluation, forecast, and provider settlement processes while collaborating with actuarial, finance, and clinical economics teams.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Data analysis

Data engineering

Data governance

Data mining

Data science

Trend analysis

Education

Bachelor's degree or higher

Tools

SQL

Job description

Blue Cross NC in Chapel Hill, NC seeks a Sr. Population Risk Performance Analyst to apply population risk models to attributed member populations and ensure defensible financial and quality performance across value-based care programs.

You will operationalize risk methodologies, support total cost of care evaluation, forecast, and provider settlement processes while collaborating with actuarial, finance, and clinical economics teams.