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

company•City of Rochester, NY

1d•Remote

About The Position

Summary: The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department that support of the Health Plans operations which monitors and maintains 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. This role monitors trends, bring forward opportunities and insights found in the data to the applicable audiences. This position supports leadership by providing statistical information and analysis needed to make informed decisions, identifies trends, and utilizes data mining techniques and development of advanced predictive models. Essential Accountabilities: All Levels Updates existing and aids 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. Maintains existing processes including but not limited to reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work. Creates and maintains appropriate documentation for work. Assists with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings. Compiles and analyzes data to draw conclusions, support data quality, and provide recommendations. Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Conducts analyses for and communicates with other departments on various initiatives. Assists the development of analyses concerning complex issues & trends, coordinates with staff Participates in reviewing and evaluating emerging trends in healthcare, establishing reserves and producing financial analysis. Recommends appropriate applications and process changes to existing and new analysis. Reconciles Data Warehouse data with corporate financials or encounter submissions and identifies and develops corrective action with regards to Data Warehouse integrity issues. Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting. Independently ideates process improvements and recommends changes in process to direct leadership. Creates and maintains documentation related to data analysis, data models, and data mapping which includes creating technical documentation, process documentation and training materials. Draws together facts and input from a variety of data sources. Level III (in addition to Level II Accountabilities) Reviews and ensures pricings are consistent with established profitability targets for relevant business segments. Researches and analyzes data across complex data ecosystem including operational and analytical data platforms to develop insightful and effective reporting and dashboards. Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems. Problem solving is complex and involves critical issues. Develops analyses concerning complex issues and trends, coordinating with several different disciplines and staff. Leads and supports departmental projects. Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy. Involves other departmental areas as needed. Level IV (in addition to Level III Accountabilities) Recommends departmental annual performance goals. Offers strategic recommendations on the analysis of data, data collection, and integration using the knowledge of best practices and business requirements. Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques. Represents the Department on special projects involving other areas of the company or external constituents. Partners and leads projects including stakeholders from a variety of departments. Interprets how regulatory changes affect Health Plan and develops impact analyses. Collaborates with senior leadership in meeting corporate goals and strategic decision making.

Requirements

Bachelor’s Degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science or relevant field required.
One (1) year of related experience preferred.
Strong analytical skills, verbal and written communication skills.
Strong interpersonal skills with demonstrated ability and willingness to collaborate with other team members.
Ability to prioritize, multitask, and maintain multiple simultaneous projects.
Intermediate technical skills including proficiency in Microsoft Office Suite
Programming skills in SQL, SAS, VBA, or similar programming language is preferred.
Two (2) years related experience.
A strong understanding of health insurance & health insurance products, managed care, accounting principles, the competitive market, the legislative environment, and any regulatory issue affecting the Health Plan.
Ability to work independently, with high level of self-motivation to improve processes.
Proficient programming skills in SQL, SAS, VBA, or similar programming language preferred.
High level understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Analytics & Data Technology, Population Health Engagement, Marketing & Sales, etc., and how they impact Health Plan operations and financials.
Four (4) years of related experience.
Ability to perform complex modeling independently.
Strong ability to recognize and automate repetitive tasks.
Ability to communicate analytical findings at the appropriate level of detail for receiving audience.
Demonstrated experience leading projects or process improvement initiatives.
Ability to write and communicate complex concepts.
Six (6) years related experience.
Advanced understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials.
Advanced ability to independently communicate analytical findings at the appropriate level of detail for receiving audience.
Strong ability to independently write, communicate and present complex concepts to both actuarial and non-actuarial audiences.

Nice To Haves

Programming skills in SQL, SAS, VBA, or similar programming language is preferred.
Proficient programming skills in SQL, SAS, VBA, or similar programming language preferred.

Responsibilities

Updates existing and aids 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.
Maintains existing processes including but not limited to reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work. Creates and maintains appropriate documentation for work.
Assists with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings.
Compiles and analyzes data to draw conclusions, support data quality, and provide recommendations.
Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Conducts analyses for and communicates with other departments on various initiatives.
Assists the development of analyses concerning complex issues & trends, coordinates with staff
Participates in reviewing and evaluating emerging trends in healthcare, establishing reserves and producing financial analysis.
Recommends appropriate applications and process changes to existing and new analysis.
Reconciles Data Warehouse data with corporate financials or encounter submissions and identifies and develops corrective action with regards to Data Warehouse integrity issues.
Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting.
Independently ideates process improvements and recommends changes in process to direct leadership.
Creates and maintains documentation related to data analysis, data models, and data mapping which includes creating technical documentation, process documentation and training materials.
Draws together facts and input from a variety of data sources.
Reviews and ensures pricings are consistent with established profitability targets for relevant business segments.
Researches and analyzes data across complex data ecosystem including operational and analytical data platforms to develop insightful and effective reporting and dashboards.
Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems. Problem solving is complex and involves critical issues.
Develops analyses concerning complex issues and trends, coordinating with several different disciplines and staff.
Leads and supports departmental projects.
Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy. Involves other departmental areas as needed.
Recommends departmental annual performance goals.
Offers strategic recommendations on the analysis of data, data collection, and integration using the knowledge of best practices and business requirements.
Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques.
Represents the Department on special projects involving other areas of the company or external constituents.
Partners and leads projects including stakeholders from a variety of departments.
Interprets how regulatory changes affect Health Plan and develops impact analyses.
Collaborates with senior leadership in meeting corporate goals and strategic decision making.