Senior Data Risk Adjustment Analyst (Remote)

CareFirst•Baltimore, MD

1d•Remote

About The Position

The purpose of a Sr. Data Analyst is to support the Health Services Risk Adjustment team through advanced analytics, reporting, and data-driven insights that enhance program performance and operational effectiveness. This position is responsible for developing and maintaining trusted data assets, producing meaningful analyses and reporting, and partnering with clinical, operational, financial, and technology teams to support Risk Adjustment initiatives across the organization. Key responsibilities include analyzing program performance, monitoring key performance indicators, supporting risk score forecasting, developing member and provider targeting methodologies, creating and maintaining dashboards and reporting solutions, performing CMS, HHS, and MDH data reconciliations, and conducting ad hoc analyses to identify opportunities for improvement. The Senior Data Analyst will translate complex data into actionable insights while adhering to established data governance, compliance, and quality standards. The ideal candidate will possess strong analytical and problem-solving skills, experience working with large healthcare datasets, and a solid understanding of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

Requirements

Bachelor's Degree in Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
5 years experience in an analytical/quantitative role.
Quantitative, analytical and problem-solving skills.
Knowledge and understanding of analytical tools, languages, applications, platforms.
Excellent communication skills both written and verbal.
Ability to learn quickly and take direction.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

Experience in Healthcare Industry
Hands-on experience with Big Data/NoSQL Platforms with experience delivering production projects at scale.
Proficiency with SQL, Power Bi, Fabric, Python, and/or SSMS.
Knowledge of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies.

Responsibilities

Perform advanced data exploration, analysis, and solution development using programming languages and analytical tools to support Risk Adjustment initiatives.
Leverage expertise across complex healthcare data structures including claims, encounters, provider, member, and risk adjustment data sources to identify trends, coding opportunities, and program improvement strategies.
Collect, analyze, and interpret Risk Adjustment data to generate actionable insights and recommendations that improve risk score accuracy, program performance, financial outcomes, and regulatory compliance.
Research, validate, and analyze data flow across operational and analytical ecosystems to ensure the integrity, completeness, and traceability of Risk Adjustment data used for reporting, forecasting, reconciliations, and regulatory submissions.
Serve as a subject matter resource for Risk Adjustment analytics, supporting stakeholders with data inquiries, business questions, and issue resolution related to risk scores, coding initiatives, program performance, and regulatory reporting.
Lead the design, development, testing, validation, and delivery of analytical solutions, dashboards, and reporting that support Risk Adjustment strategy, targeting initiatives, operational decision-making, and program effectiveness measurement.
Partner with business and technical stakeholders to gather requirements and deliver data-driven solutions supporting Medicare, Medicaid, and ACA Risk Adjustment programs.
Develop and maintain technical documentation, business requirements, data specifications, and process documentation consistent with organizational standards.