Senior Consultant, Quality & Risk Adjustment Analytics

Health insurance that's with you, every step of the way. • Minnetonka, MN

1d • Hybrid

About The Position

Medica is a nonprofit health plan serving more than a million members in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The Senior Consultant, Quality & Risk Adjustment Analytics serves as a senior analytical thought partner to Population Health & Quality leadership, providing independent analytical expertise across Quality and Risk Adjustment. The role combines healthcare performance knowledge with hands-on analytical capabilities to access, integrate, validate, and analyze complex healthcare data and translate findings into actionable business insights.

The position identifies trends, performance drivers, emerging risks, and opportunities across Quality and Risk Adjustment; investigates underlying causes and business implications; and develops clear, decision-oriented reporting and recommendations for executive and cross-functional stakeholders. It works with business, clinical, provider, financial, operational, and analytics partners to strengthen performance intelligence and support enterprise decision-making. The role is an office position requiring onsite work at the Minnetonka, Minnesota office an average of three days per week. Other duties may be assigned.

Requirements

• Bachelor's degree or equivalent experience in a related field.
• At least 8 years of applicable experience in healthcare analytics, health insurance, Quality, Risk Adjustment, healthcare performance, or a related field.
• Legally authorized to work in the United States at the time of application; employment is contingent on verification of identity and work eligibility. Medica does not offer work visa sponsorship for this role.

Nice To Haves

• Demonstrated experience analyzing healthcare performance across Quality, HEDIS, Stars, Risk Adjustment, or closely related health plan performance domains.
• Ability to independently interpret complex healthcare data and identify trends, performance drivers, risks, and opportunities.
• Advanced SQL skills, including independently querying, joining, validating, and analyzing large, complex datasets.
• Experience using Python, R, or comparable analytical programming tools for healthcare data analysis.
• Experience working with healthcare claims, encounters, membership, provider, clinical, Quality, or Risk Adjustment data.
• Experience conducting root-cause, trend, variance, cohort, and performance-driver analyses.
• Ability to translate complex analytical findings into clear business insights and recommendations for senior leadership.
• Strong understanding of healthcare performance measurement and the relationships among clinical performance, provider performance, member outcomes, regulatory requirements, and financial performance.
• Ability to work independently on complex, ambiguous analytical questions and determine an appropriate analytical approach.
• Strong communication, critical-thinking, problem-solving, and executive presentation skills.
• Ability to partner effectively across business, clinical, technical, financial, and operational stakeholders.

Responsibilities

• Independently analyze Quality and Risk Adjustment performance to identify trends, variation, emerging risks, and improvement opportunities.
• Conduct root-cause, variance, cohort, provider, member, market, and other analyses to determine performance drivers.
• Integrate Quality and Risk Adjustment data and perspectives to identify relationships and signals that may not be apparent when each domain is evaluated separately.
• Evaluate results in the context of business objectives, regulatory requirements, provider performance, member outcomes, and financial implications.
• Develop hypotheses, test explanations, and distinguish meaningful performance signals from normal variation or data anomalies.
• Translate analytical findings into business implications, risks, opportunities, and recommended actions.
• Develop executive-level reporting that explains what changed, why it matters, key drivers, and where intervention or further investigation may be warranted.
• Serve as an analytical thought partner to the Vice President, Population Health & Quality, and other senior leaders.
• Present complex findings clearly and concisely to technical and non-technical audiences.
• Develop and monitor performance indicators and identify changes requiring leadership attention.
• Support strategic planning, forecasting, performance reviews, business cases, and other executive decision-making through targeted analysis.
• Challenge assumptions and reported results when data or observed performance warrants further investigation.
• Partner with Quality, Risk Adjustment, Population Health, Provider, Clinical, Finance, Operations, Analytics, Technology, and other functions to support enterprise performance improvement.
• Provide subject matter expertise on Quality and Risk Adjustment data, measurement, performance, and analytical interpretation.
• Help stakeholders translate business questions into appropriate analytical approaches and actionable measures.
• Promote consistent definitions, analytical rigor, data transparency, and effective use of performance information.
• Identify opportunities to improve analytical processes, tools, data accessibility, and organizational performance intelligence.
• Perform other duties as assigned.

Benefits

• Competitive medical, dental, and vision benefits.
• Paid time off (PTO).
• Paid holidays.
• Paid volunteer time off.
• 401(k) contributions.
• Caregiver services.
• The position may be eligible for incentive plan compensation in addition to base salary.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior