Senior Insights Analyst

Blue Cross and Blue Shield of North Carolina•Remote Flex - North Carolina, NC

4d•$98,092 - $156,947•Hybrid

About The Position

The Senior Insights Analyst provides advanced analytical support for ACA risk adjustment, including data collection, model implementation, trending, forecasting, validation, reporting, and financial reconciliation. The role serves as a primary analytical resource for ACA risk adjustment activities, preparing and interpreting complex data for internal and external customers, investigating discrepancies across data sources and systems, and translating findings into clear business insights. The analyst partners with Actuarial, regulatory submission, value-based program, vendor, and operational stakeholders. The role also improves analytical controls, documentation, automation, and recurring processes; supports regulatory and financial analysis; and helps stakeholders make financial, operational, regulatory, and strategic decisions. The position requires careful handling of protected health information and includes user support, cross-functional project work, and mentoring less experienced employees. The role follows Blue Cross NC’s Hybrid-Flex or Remote-Flex approach, depending on the nature of the work and distance from the Durham headquarters. Hybrid-Flex employees work in the office at least two days per week; Remote-Flex employees work virtually with a few in-office visits each year. Onsite expectations are discussed during the interview process.

Requirements

Bachelor’s degree or advanced degree where required; in lieu of a degree, 7+ years of experience in a related field.
5+ years of experience in a related field.
Ability to use SQL, Python, and other approved platforms for complex data analysis and reporting.

Nice To Haves

Experience with healthcare analytics, preferably ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or related regulatory analytics.
Advanced SQL skills and experience using Python or comparable analytical tools to develop, validate, and maintain complex, repeatable data processes.
Ability to validate member-level risk scores or other financially significant outputs, reconcile results across systems, and perform root-cause analysis of discrepancies.
Experience translating complex results into clear insights for Actuarial, Finance, regulatory, operational, or provider-facing stakeholders.
Experience supporting recurring processes with overlapping deadlines and high accuracy requirements, including documentation, controls, peer-review routines, and process improvements.
Ability to independently lead analytical work, coordinate across cross-functional teams and external vendors, communicate risks and recommendations, and work effectively with limited supervision during critical business cycles.

Responsibilities

Use SQL, Python, and other approved analytical and reporting tools to access, investigate, validate, and analyze complex healthcare data.
Develop, analyze, report, and interpret complex data for ongoing activities and projects, ensuring outputs are accurate, documented, and delivered by established deadlines.
Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production.
Perform trend, variance, and root-cause analysis to explain changes in risk scores, transfer estimates, regulatory submission results, and provider settlement outputs.
Reconcile outputs across analytical processes and source systems, identify discrepancies, and coordinate issue resolution with business, technical, and operational partners.
Support and manage complex analytical applications across platforms and coordinate code migrations and changes between application environments.
Maintain cross-functional programs and develop analytical processes, controls, reports, and tools that improve accuracy, repeatability, and transparency.
Improve report-generation processes by optimizing data ingestion, manipulation, profiling, validation, and documentation.
Collaborate with customers to complete analyses and provide analytical support and problem-solving assistance to business areas.
Identify complex trends and make actionable recommendations for financial, operational, regulatory, and strategic decision-making.
Present findings, risks, and recommendations clearly to technical and non-technical audiences, including leadership.
Represent the department on cross-functional project teams and process optimization efforts involving analysis, interviews, procedure design, documentation, and implementation.
Coordinate analytical support for external vendor engagements and validation activities, as assigned.
Protect data containing protected health information and address security or privacy concerns in accordance with company requirements.
Provide ongoing user support for ad hoc reporting, questions, data inquiries, and analytical problem resolution.
Mentor or coach less experienced employees and contribute to cross-training and knowledge continuity.