Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!
Your Role
The Blue Shield's Risk Adjustment (RA) team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The RA team is looking to expand our analytics around Risk Adjustment Data Validation (RADV) and risk adjustment policy.
The Analytics-RADV Consultant will report to the Sr Manager of RADV analytics. In this role you will work with the Sr Mgr, to help expand Blue Shield's RADV related initiatives across all lines of business (from Individual and Small Group to Medicare Advantage). This role will be key in understanding existing and new strategic and policy implications around RADV, while also consolidating tracking of existing RADV programs, into a unified view.
Your Work
In this role, you will:
Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
Train lower-level analysts on how to update and apply these advanced analytic techniques
Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
Partner with the Sr. Mgr to identify strategies for RADV analytics across business lines, including understanding (1) key goals [what/when], (2) lead measures, (3) current blockers [how]
Liason with Corporate Actuarial and Pricing on RADV financial estimates and implications, that also includes understanding results from the vendor Wakely, understanding the changes in RADV impact between quarters and years, and annually reading and understanding changes in the new RADV program annually for Individual and Small Business as well as Medicare Advantage
May help partner in coordinating a central consolidation file for RADV accruals with Corporate Actuarial and Pricing
May help partner in reading and understanding annual regulatory summaries on RADV by Legal and Policy teams
Support analytics and project-driving of RADV enterprise projects, for example: helping to stand up a new RADV process for Medicare Advantage
Your Knowledge and Experience
Requires a bachelor's degree or equivalent experience
Requires at least 6 years of professional experience
Requires 4 years+ of Risk Adjustment experience, including basic proficiency with MS Office assumed (including Excel, Word, PowerPoint)
Requires ability to create and validate new and existing data analytic processes, in context of broader enterprise objectives. This assumes knowledge and ability to run, debug existing complex data-analytic processes. Requires proficiency in at least 1 or more programming languages [Sample code required]
Requires ability to juggle multiple complex tasks simultaneously and message clearly to dependent party when one task is slipping relative to another. This assumes excellent written and spoken communication skills of technical material to executive leadership [Sample executive communication required]
Desires excellent program management skills, along with related ability to rapidly diagnose to root-cause of analytic problems, including excellent mentorship skills
Desires you to have experience with (1) the HHS-Developed Risk Adjustment Model Algorithm for the commercial market (2) Finance experience, including revenue and expense accounting (3) Healthcare Enrollment and Claims processing experience (4) healthcare experience, especially technical experience
Additional Information
About Company: o About Blue Shield of California: For more than 80 years, Blue Shield has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 7,500 employees, more than $21 billion in annual revenue and 4.5 million members. The company has contributed more than $500 million to the Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield is headquartered in Oakland, California with 21 additional locations including Sacramento, Los Angeles, and San Diego. o Our Benefits: At Blue Shield you can expect a comprehensive benefits program that offers choice and flexibility for our diverse workforce. These programs and resources include: Medical, Dental, and Vision plan benefits, 401(k) with employer match, paid time off (PTO), earned sabbatical time, paid nonprofit volunteer time, flexible work program, free online education, tuition reimbursement, a wellness reimbursement program, 12 weeks paid parental leave, and more.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.
EEO Footer: o EEO Footer: All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, state and local laws. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. o Accommodations: Blue Shield is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, services, programs and activities. To request a reasonable accommodation prior to your interview, please contact RehabWest, Inc at (760)759-7500.
