Capital Blue Cross · 17 hours ago
Senior Risk Adjustment Analyst (Medicare)
US-PA-Harrisburg
Full-time
Onsite
Senior Level
5+ years expCapital Blue Cross is committed to enhancing the health and well-being of its members and communities. The Senior Risk Adjustment Analyst role involves supporting risk revenue management initiatives for Medicare and ACA programs, focusing on analytics, program management, and improving quality of care while ensuring compliance and ethical practices.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
Analyze large datasets to identify trends, patterns, and insights related to coding output, with a focus on improving quality
Take ownership of complex data workflows by building and maintaining scalable analytics pipelines using data tools such as SQL, SAS, and Snowflake
Leverage technical expertise to streamline recurring and/or ad-hoc analyses into reusable, scalable data products
Collect, interpret, and aggregate data from multiple sources to support risk adjustment, medical record coding, government audits, and quality initiatives
This position supports the development of risk-related policies, procedures, and governance strategies, identifies opportunities to improve processes and efficiency, and delivers actionable insights through enterprise reporting and analytics tools such as SQL, SAS, Snowflake, and Power BI
Qualification
Required
Deep understanding of and experience in Risk Adjustment (MA & ACA) business analytics with knowledge of different risk models including HCC, RxHCC, HHS-HCC and CDPS
Knowledge of Healthcare Plan systems, applications, databases and their underlying data structures, including but not limited to claims, eligibility and provider
5 years' experience in data analysis, database technologies (Snowflake, SAS), SQL queries, etc
Experience analyzing risk adjustment data for trends, disease/diagnosis prevalence and condition hierarchy
Experience designing, building, and maintaining databases or analytical data structures
Experience creating detailed reports and communicate complex data structures
Possess high level of interpersonal skills
Strong problem-solving skills with the ability to think critically and provide data driven solutions
Ability to adapt to changing priorities of multiple customers
Advanced proficiency with SQL query techniques and exposure to business intelligence tools with advanced proficiency in SAS, Power BI, and Snowflake
Advanced skills in Microsoft Excel
Bachelor's Degree in Analytics, Information Systems, or related field or 9 years of relevant experience in lieu of degree
Preferred
Prefer foundational knowledge of predictive modeling and statistical analysis techniques
Prefer experience with advanced analytics tools and programming languages, such as Python
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
H1B Sponsorship
Capital Blue Cross has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (13)
2023 (5)
2022 (9)
2021 (5)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Todd Shamash
President and CEO
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
Company data provided by crunchbase