Senior Analyst, Medical Economics – Stars and Risk Adjustment

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and uphold standardized reporting for Stars and Risk Adjustment utilizing internal data sources and CMS files within Databricks and Power BI.

• Oversee code development and the creation of end-user dashboards, leveraging subject-matter expertise to fulfill specified business requirements.

• Act as a subject matter expert on Risk Adjustment data sources, including MAO-004, 837, MMR, and MOR files.

• Deliver internal presentations and detailed analytical insights to stakeholders to ensure understanding and alignment on subsequent actions.

• Examine data to uncover trends and performance opportunities, while formulating action plans to address identified gaps.

• Cultivate an in-depth understanding of clinical workflows and collaborate to refine processes that enhance departmental efficiency and effectiveness.

• Work together with internal teams to provide insights that could impact underwriting, contracting, operations, and other business sectors.

• Promote the development of direct and matrixed team members by encouraging knowledge-sharing and sustainable advancement toward departmental objectives.

⛳️ Requirements

• Bachelor’s degree is required; a Master’s degree in healthcare or a related discipline, or progress towards an actuarial certification (FSA/ASA) is preferred.

• At least two (2) years of experience in Medicare Advantage Stars or Risk Adjustment analytics.

• Proficient in SQL, R, and Python; experienced in working with large enterprise data warehouses; strong capability to build, modify, and optimize data tables; intermediate-to-advanced skills in Power BI, including complex DAX and data modeling.

• Familiarity with CMS Risk Adjustment and Stars data sources (MAO-004, 837, MMR, MOR).

• Capacity to convert data into clear, actionable insights.

• Strong communication skills and the ability to collaborate within a matrixed environment, influencing others to achieve desired outcomes.

🏝️ Benefits

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts.

• Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources.

• Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave.

• Wellness & Growth – Work-life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts.