Principal Health Business Analytics - Risk Adjustment

Job Summary

Job Summary: The Principal, Health Business Analytics leads analytic strategy and execution for Medicare Risk Adjustment programs, driving insights that optimize revenue, compliance, and operational performance. This role partners with cross-functional leaders to translate complex data into actionable strategies that improve risk score accuracy, evaluate program effectiveness, and support executive decision-making. The Principal Health Business Analyst applies expertise to initiatives of the highest risk, complexity and impact to the business, solves the most critical issues, serves as a strategy influencer, applies knowledge of emerging trends and industry practices and is responsible for coaching, training and providing technical oversight to others.

• Lead analytic strategy for risk adjustment and align insights with enterprise financial and compliance goals.
• Analyze risk score trends, model performance, and program results to identify revenue and quality improvement opportunities.
• Partner with Finance and Actuarial to forecast revenue and assess CMS model impacts (e.g., V24 V28).
• Evaluate vendor, provider, and campaign performance for prospective, retrospective, and encounter programs.
• Ensure analytic integrity, data accuracy, and compliance with CMS risk adjustment requirements.
• Deliver clear, actionable insights and visualizations to senior leadership.
• Mentor analysts and advance the use of predictive modeling, automation, and performance dashboards.
• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Serve as strategy influencer and subject matter expert on assigned projects of high risk, complexity and impact to the business.
• Manipulate data using large datasets and multiple data sources.
• Act as primary Analyst for large projects and proactively identify topics for analysis.
• Analyze or assist in the analysis of processes and programs in achieving stated goals. Provide analyses and recommendations if corrections are needed. Investigates and discovers areas of opportunity.
• Develop advanced Excel-based models and spreadsheets containing advanced functions that are used to evaluate historical trends and forecasts and to identify best practices.
• Write advanced SAS and/or SQL programs for data extraction. Integrate data across multiple areas. Modifies existing programs for data extraction.
• Apply risk adjusters when applicable.
• Accountable for developing insightful and actionable summaries and recommending actions.
• Monitor and evaluate patterns, costs and trends.
• Recommend new analytical processes; partner with Information Management in the development of new analytical tools such as power pivots and analytical cubes to enhance analytical capabilities.
• Train team members on analytical tools and techniques including complex SAS and/or SQL, advanced Excel and detailed risk/analytical models. Provide guidance and review work of team members.
• Monitor emerging trends, provides strategy input to Director, prepares benchmarking reports and recommendations.
• Lead development of industry leading analytical methods, tools and models.

• 8+ years related work experience. Experience Details:
  Risk Adjustment
• Related Bachelor's degree or additional related equivalent work experience
• Experience using algorithms and inferential statistics.
• Advanced level experience writing SQL /SAS or related code
• Advanced Excel skills
• Proficient with Microsoft Office products
• Ability to manage tasks independently, take ownership of responsibilities and meet deadlines
• High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy
• Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
• Ability to train team members on advanced analytical tools and techniques (complex SAS and/or SQL, advanced Excel and detailed risk/analytical models)
• In-depth business process knowledge of several key business functional areas
• Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences
• Expert innovator with ability to think beyond established standards and processes
• Expert-level knowledge and experience applying current and emerging trends
• Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills
• 4 or more years of experience with health business

• Bachelor's degree Business Analytics, Health Economics, or similar program
• Master's degree

General Physical Demands:
Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer: As a Florida Blue employee, you will thrive in our Be Well, Work Well, Guide Well culture where being well as an individual, and working well as a team, are both important in serving our members and…