Senior Risk Adjustment Analyst — HCC & RAF Insights

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

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.