Senior Insights Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Deliver comprehensive analytical support for ACA risk adjustment initiatives.

• Gather data, execute models, conduct trending, forecasting, validation, reporting, and financial reconciliation.

• Act as the main analytical resource for ACA risk adjustment efforts.

• Prepare and decode complex data for both internal and external stakeholders.

• Examine discrepancies across various data sources and systems, translating insights into actionable business intelligence.

• Collaborate with Actuarial, regulatory submission, value-based program, vendor, and operational partners.

• Enhance analytical controls, documentation, automation, and ongoing processes.

• Utilize SQL, Python, and other authorized platforms to access, investigate, validate, and analyze intricate healthcare data.

• Assist in the implementation, testing, validation, and ongoing member-level RAF score production for ACA risk adjustment models.

• Conduct trend, variance, and root-cause analyses.

• Reconcile outputs across analytical processes and source systems while managing issue resolution.

• Oversee analytical applications across various platforms, coordinating code migrations and environmental changes.

• Create analytical processes, controls, reports, and tools.

• Streamline report-generation data ingestion, manipulation, profiling, validation, and documentation.

• Provide analytical support and problem-solving assistance to various business areas.

• Offer actionable recommendations for financial, operational, regulatory, and strategic decision-making.

• Present findings, risks, and recommendations to both technical and non-technical audiences, including leadership.

• Represent the department in cross-functional project teams and process optimization initiatives.

• Coordinate analytical support for external vendor engagements and validation procedures.

• Offer user support for ad hoc reporting, data inquiries, and analytical problem-solving.

• Mentor or coach junior employees and contribute to knowledge continuity and cross-training efforts.

⛳️ Requirements

• Bachelor's degree or advanced degree (if required), or 7+ years of experience in a relevant field in place of a degree.

• At least 5 years of experience in a related domain.

• Proficiency in healthcare analytics, ideally with ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or similar regulatory analytics.

• Advanced skills in SQL.

• Experience with Python or similar analytical tools to develop, validate, and maintain complex, repeatable data processes.

• Capability to validate member-level risk scores or other financially significant outputs.

• Experience reconciling results across systems and conducting root-cause analyses of discrepancies.

• Ability to convert complex results into clear insights for Actuarial, Finance, regulatory, operational, or provider-facing stakeholders.

• Experience supporting recurring processes with overlapping deadlines and high accuracy expectations.

• Familiarity with creating documentation, controls, peer-review routines, and process enhancements.

• Demonstrated ability to independently lead analytical efforts and coordinate across cross-functional teams and external vendors.

• Strong communication skills to articulate risks and recommendations.

• Ability to work effectively with minimal supervision during critical business periods.

• Commitment to ensuring security and privacy for data containing protected health information.

🏝️ Benefits

• Enjoy work-life balance, flexibility, and autonomy.

• Comprehensive medical, dental, and vision coverage.

• Access to health and wellness programs.

• Parental leave and support options.

• Assistance with adoption and surrogacy.

• Opportunities for career development.

• Tuition reimbursement for further education.

• 401(k) matching, including an annual company contribution.

• Annual Incentive Bonus.

• Paid Time Off (PTO).