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Excellus BCBS · 18 hours ago

Healthcare Statistical Analyst & Product Family Owner I

DeWitt, NY

Full-time

Hybrid

Mid, Senior Level

$79K/yr - $142K/yr

5+ years exp

Excellus BCBS is seeking a Healthcare Statistical Analyst & Product Family Owner I to support health plan operations through data analysis and modeling. This role involves monitoring trends, providing statistical insights, and overseeing operational strategies to identify growth opportunities.

Health CareHealth InsuranceNon Profit

Work & Life Balance

Responsibilities

Updates existing and aids in the creation of new analysis pertaining to benefit designs, claims experience, Value Based Payment (VBP) programs and valuation of internal and externally led claims savings and risk adjustment initiatives and communicates with other departments on various initiatives

Maintains existing processes including but not limited to reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work. Draws together facts and input from a variety of data sources

Leads and supports departments projects, including assisting with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings

Initiates and leads efforts relating to and independently compiles, analyzes, and researches data across complex data ecosystem including operational and analytical data platforms to develop insightful and effective reporting and dashboards, support data quality, provider recommendations, and coordinate with staff

Develops analyses concerning complex issues and trends, coordinating with several different disciplines and staff

Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems. Problem solving is complex and involves critical issues

Reconciles Data Warehouse data with corporate financials or encounter submissions and identifies and develops corrective action with regards to Data Warehouse integrity issues

Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed

Reviews and ensures pricings are consistent with established profitability targets for relevant business segments

Creates and maintains documentation related to data analysis, data models, and data mapping which includes creating technical documentation, process documentation and training materials

Utilizes an exceptional understanding of health plan operations, systems, and customers

Creates a backlog of minimum viable products

Oversees the design, development, implementation, and socialization of operational system strategy and communications for the organization across the Health Plan

Strategically leads and/or participates in innovative thinking and idea generation that will transform the customer experience

Works to integrate data analytics, performance metrics, competitive and market analysis, and company goals to drive prioritization of set initiatives

Develops relationships with key areas vital to the success of all products within their product family to understand their vision, strategies, and desired capabilities needed to integrate them into a comprehensive strategy and roadmap

Serves as Change management model champion and change agent for this role and the new process

Identifies trends and innovative opportunities in anticipation of future needs of our customers and organization

Understands and aligns operational capabilities roadmap and recommendations to Federal regulations, compliance standards, and industry best practices

Aggregates constituent backlogs into a single prioritized product family backlog

Understands, manages, and communicates prioritization of product features with a mind toward user and business benefits/tradeoffs

Provides documentation as needed (i.e. vision board, scope, workflow, use cases, requirements, and other materials) to support the teams

Defines release success criteria and ensures the success metrics are realized

Works with the TPO to elaborate requirements including high-level Conditions of Acceptance (CoAs)

Interfaces with leaders and/other PPOs to manage dependencies with integrated projects

Proactively manages product family-level changes in project scope and mitigates potential risks thereof

Maintains/develops relevant industry knowledge and relationships to further knowledge and product family expertise

Collaborates with the Leadership Team to implement key initiatives (Maximize Quality, Surmount Delivery, Enhanced Predictability, Control Risk, Scale the Organization, Create an Innovative Organization, Unify the Organization)

Mentors' others in the product family when needed

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

Regular and reliable attendance is expected and required

Performs other functions as assigned by management

Offers strategic recommendations on the analysis of data, data collection, and integration using the knowledge of best practices and business requirements

Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques

Represents the Department on special projects involving other areas of the company or external constituents

Partners and leads projects including stakeholders from a variety of departments

Interprets how regulatory changes affect Health Plan and develops impact analyses

Recommends departmental annual performance goals

Collaborates with senior leadership in meeting corporate goals and strategic decision making

Qualification

Statistical analysisData mining techniquesPredictive modelingSQL programmingSAS programmingVBA programmingAgile methodologyProject managementInterpersonal skillsCommunication skillsOrganizational skillsProblem-solvingSelf-motivation

Required

Five (5) years of related experience required, with participation in Society of Actuaries (SOA) exams preferred

Bachelor's degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science or relevant field required

Ability to prioritize, multitask, and maintain multiple simultaneous projects, with a strong ability to recognize and automate repetitive tasks, and demonstrated experience leading projects or process improvement initiatives

Strong interpersonal, verbal and written communications and organizational skills and ability to engage at the executive level, with the ability to write and communicate complex concepts

High level understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Analytics & Data Technology, Population Health Engagement, Marketing & Sales, etc., and how they impact Health Plan operations and financials

Ability to work & perform complex modeling independently, with high level of self-motivation to improve processes

Self-motivated, able to analyze problems and identify solutions with minimal direction, flexible, able to meet deadlines, and work well in a fast-paced, high volume team environment

Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer

Ability to travel across the Health Plan service region for meetings and/or trainings as needed

Ability to work in a home office for continuous periods of time for business continuity

Preferred

Proficient programming skills in SQL, SAS, VBA, or similar programming language is preferred

Experience as a process/project/program manager, with demonstrated accomplishments delivering project features/capabilities preferred

Experience with Agile or Scaled Agile experience (either working in Agile/SAFe environment preferred or experience rolling out new to organization Agile methodology) or a genuine willingness to learn

Seven (7) years of related experience required, with participation in Society of Actuaries (SOA) exams preferred

Experience as an Agile Product Owner or equivalent preferred

Advanced understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials

Advanced ability to independently communicate analytical findings at the appropriate level of detail for receiving audience

CSM or CSPO Certification or Lean Six Sigma Green Belt a plus

Advanced communication skills with the ability to present complex concepts to both actuarial and non-actuarial audiences

Benefits

Participation in group health and/or dental insurance

Retirement plan

Wellness program

Paid time away from work

Paid holidays

Company

Excellus BCBS

Glassdoor4.0

Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to about 1.5 million people across upstate New York.

Founded in 1932

Rochester, New York, USA

5001-10000 employees