Risk Adjustment Healthcare Statistical Analyst I​/II​/III​/IV

Job Description

The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department that support the Health Plans operations, monitoring and maintaining financial solvency through the understanding of current data & environment and modeling of future events. This role interacts with internal and external partners and regulatory agencies, monitors trends, brings forward opportunities and insights found in the data to the applicable audiences, and supports leadership by providing statistical information and analysis needed to make informed decisions.

The analyst identifies trends and utilizes data mining techniques, including the development of advanced predictive models.

• Update existing and aid in the creation of new analysis pertaining to benefit designs, claims experience, Value Based Payment (VBP) programs, and valuation of internal and externally led claims savings and risk adjustment initiatives.
• Maintain existing processes including reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work; create and maintain appropriate documentation for work.
• Assist with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings.
• Compile and analyze data to draw conclusions, support data quality, and provide recommendations.
• Propose and assist in developing process improvements utilizing system and software applications to full potential and participate in activities and projects as directed.
• Consistently demonstrate high standards of integrity by supporting the lifetime healthcare company’s mission and values, adhering to the corporate code of conduct, and embodying the Lifetime Way values and beliefs.
• Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
• Ensure regular and reliable attendance.
• Perform other functions as assigned by management.

• Conduct analyses for and communicate with other departments on various initiatives.
• Assist in the development of analyses concerning complex issues & trends, coordinating with staff.
• Participate in reviewing and evaluating emerging trends in healthcare, establishing reserves and producing financial analysis.
• Recommend appropriate applications and process changes to existing and new analysis.
• Reconcile Data Warehouse data with corporate financials or encounter submissions and develop corrective action regarding Data Warehouse integrity issues.
• Initiate and lead efforts to improve data capabilities and the quality of department analysis and reporting.
• Independently ideate process improvements and recommend changes in process to direct leadership.
• Create and maintain documentation related to data analysis, data models, and data mapping, including technical documentation, process documentation and training materials.
• Draw together facts and input from a variety of data sources.

• Review and ensure pricings are consistent with established profitability targets for relevant business segments.
• Research and analyze data across complex data ecosystems, including operational and analytical data platforms, to develop insightful and effective reporting and dashboards.
• Demonstrate keen judgment on involved and complex assignments; devise methods and procedures to meet unusual conditions and make original contributions to solving very difficult problems. Problem solving is complex and involves critical issues.
• Develop analyses concerning complex issues and trends, coordinating with several different disciplines and staff.
• Lead and support departmental projects.
• Provide effective technical advice and support to assist management in meeting corporate goals and identifying strategy, involving other departmental areas as needed.

• Recommend departmental annual performance goals.
• Offer strategic recommendations on the analysis of…