Key Facts

Remote From:

Tennessee (USA)

Category: Consultant

Freelance

Senior (5-10 years)

English

Hard Skills

Health Care Risk Management Data Visualization Statistical Analysis SQL (Programming Language) Python (Programming Language) Tableau (Business Intelligence Software) Power BI Project Management Data Blending Healthcare Analytics +5 more

Other Skills

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Analytical Skills
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Communication
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Presentations
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Teamwork
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Time Management
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Problem Solving

Roles & Responsibilities

Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics
Understanding of data querying from various sources
Strong analytical skills and proficiency in SQL, Python, R
Excellent communication and presentation skills

Requirements:

Drive analytical strategies and solutions for Medicare Risk Adjustment performance
Build interactive visualizations and interpret CMS model updates
Provide strategic advisory services to internal stakeholders
Analyze for revenue optimization, risk forecasts, and HCC coding logic

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 Principal Risk Adjustment Consultant drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. Leveraging deep healthcare expertise and advanced coding proficiency, this role delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership.
Core responsibilities include analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance. The Principal Risk Adjustment Consultant will build interactive visualizations, interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics and translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership

Required Job Qualifications:

Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master’s degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field

Understanding, and being highly proficient at querying a wide variety of internal and external data sources to get meaningful insights.

Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc.

Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.

High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.

Excellent communication and presentation skills.

Ability to work independently and as part of a team.

Ability to lead multiple analytic related projects in parallel.

Analytics subject matter expert

Performance excellence in championing initiatives and collaborating with multiple stakeholders to bring the initiative to life.

Ability to work under pressure and delivery high quality output to senior leadership to decision making within short timeline.

Preferred Job Qualifications:

Deep experience with Medicare Risk Adjustment and Stars.

Advanced analytics & automation using Alteryx or Airflow for data blending and automation.

Proficiency with GitHub for collaborative coding and version control.

Certification or practical experience with project management methodologies and tracking tools (e.g., Agile, Wrike, PMP), and exposure to data science in healthcare including hands-on experience working with predictive models, machine learning pipelines, or Large Language Models (LLMs).

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.