Key Facts

Remote From:

Full time

Senior (5-10 years)

English

Hard Skills

Health Care Risk Management Predictive Modeling Data Visualization Data Manipulation SQL (Programming Language) Base SAS Python (Programming Language) Tableau (Business Intelligence Software) Power BI Presentation Training +1 more

Other Skills

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Consultative Approaches
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Negotiation
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Decision Making
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Organizational Skills
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Non-Verbal Communication

Roles & Responsibilities

Bachelor Degree in Math, Actuarial Science, Business Statistics, Accounting or Finance OR 4 years experience
5 years experience interfacing with external clients, large employers, brokers, or consultants
5 years experience in requiring data analysis and information reporting related to healthcare data
2 years leadership experience

Requirements:

Serve as the primary consultative resource for strategic initiatives
Lead cross-functional, matrixed teams and work directly with risk adjustment analysts
Translate complex risk adjustment analyses into high-impact strategic recommendations and presentations
Oversee the design and execution of complex data initiatives

Health Care Service Corporation

About Health Care Service Corporation

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status.

Company type: XLarge

Founded: 2018

Company size: 10001

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Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

The Medicare Risk Adjustment Analytics Consulting Manager is a Subject Matter Expert (SME) who will drive revenue integrity and analytics strategy by serving as the primary consultative resource for strategic initiatives. This role leads cross-functional, matrixed teams and works directly with risk adjustment analysts to transform complex financial and risk adjustment data into actionable business intelligence. Additionally, the SME champions advanced data science initiatives by supporting the end-to-end development, refinement, and deployment of predictive models. As a key advisor to the business, the SME consistently delivers strategic, data-driven insights and collaborates with key stakeholders to ensure revenue accuracy and analytic product integrity.
Core responsibilities include consultive leadership, translating complex risk adjustment analyses into high-impact strategic recommendations and presentations. The manager is a strategic advisor, collaborates with key business partners and oversees the design and execution of complex data initiatives.

JOB REQUIREMENTS:

Bachelor Degree in Math, Actuarial Science, Business Statistics, Accounting or Finance OR 4 years experience.
5 years experience interfacing with external clients, large employers, brokers, or consultants OR 5 years experience in presenting analytic results to both internal and external audiences.
5 years experience in requiring data analysis and information reporting related to healthcare data.
2 years leadership experience.
Negotiation, decision-making, organizational, and analytical skills.
Verbal and written communication skills, including presentation skills.
PC proficiency to include Access, Excel, Word, and PowerPoint.

PREFERRED JOB REQUIREMENTS:

Deep Medicare Risk Adjustment experience (HCC models, risk score calculations, RADV audits).
Proven success leading data projects and influencing indirect reports, peers, and cross-functional teams in a complex environment and without formal authority.
Advanced understanding of querying, manipulating, and visualizing healthcare data (e.g.' SQL, SAS, Python, Tableau or Power BI).
Exceptional presentation skills reporting to C-suite or executive-level stakeholders including the ability to simplify complex data analyses into business insights for non-technical partners.

This is a Remote role.

#LI -PD1
#LI-REMOTE

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.