Job Description
Serves as a strategic analytics partner to the Federal Employee Program (FEP) Clinical Operations team by delivering actionable business intelligence, operational reporting, financial insights, and data-driven recommendations that support program performance, member outcomes, operational effectiveness, and strategic initiatives. This role combines advanced data analysis, dashboard development, healthcare claims expertise, clinical program measurement, and stakeholder engagement to identify opportunities to improve quality, cost, experience, and operational efficiency.
The analyst develops reporting and analytical solutions that support care management programs, utilization management initiatives, quality improvement efforts, member engagement strategies, FEP performance goals, and executive decision-making. This role is responsible for translating complex healthcare and operational data into meaningful insights, measuring program effectiveness, identifying trends and improvement opportunities, and driving measurable outcomes across Clinical Operations for the Federal Employee Program.
- Partner with Clinical Operations, FEP Business Operations, and Quality stakeholders to identify business needs and develop analytical solutions that support program performance, member outcomes, cost management, and operational excellence.
- Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics solutions that provide actionable insights into clinical program effectiveness, member engagement, quality metrics, productivity, operational performance, and key business indicators.
- Analyze healthcare claims, member, provider, care management, utilization, quality, and operational data to identify trends, performance gaps, emerging risks, and opportunities for clinical and operational improvement.
- Develop recurring and ad hoc operational and financial reporting used by leadership to monitor program outcomes, resource utilization, productivity, quality performance, member experience, and strategic objectives.
- Support the design, execution, validation, and documentation of analytical methodologies used to evaluate program effectiveness, measure intervention outcomes, assess performance improvement opportunities, and support business decision-making.
- Collaborate with business partners, BI Analysts, Data Scientists, and others to define data requirements, improve data quality, and operationalize advanced analytical solutions.
- Facilitate requirements gathering, solution design, and stakeholder review sessions to ensure reporting and analytical solutions meet business objectives and deliver measurable value.
- Validate data accuracy, reconcile reporting outputs, and ensure consistency of financial, operational, and analytical metrics across multiple systems and audiences.
- Communicate analytical findings, insights, risks, and recommendations to business partners and leadership through effective visualizations, presentations, and written summaries.
- Establish and maintain reporting standards, documentation, governance practices, and development methodologies to ensure scalable, reliable, and sustainable analytical solutions.
- Manage multiple projects and priorities simultaneously while proactively communicating status, risks, dependencies, and opportunities to stakeholders and leadership.
Hiring Requirements
- Bachelor's degree or advanced degree (where required)
- 3+ years of experience in related field.
- In lieu of degree, 5+ years of experience in related field.
- Strong analytical, problem-solving, and communication skills.
Preferred
- Experience supporting Care Management, Utilization Management, Quality Improvement, Population Health, or Federal Employee Program (FEP) initiatives.
- Knowledge of healthcare claims processing, CPT, HCPCS, ICD-10, DRG, Medical Cost Groupers (MCG), and HEDIS.
- Experience measuring clinical program outcomes, quality performance, member engagement, utilization trends, cost of care, and operational performance metrics.
- Experience evaluating healthcare interventions and conducting program effectiveness analyses.
- Experience with Snowflake
- Experience building AI agents
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$89,174.00 - $142,679.00
Skills
Business Analysis, Business Data Analytics, Business Intelligence (BI), Cloud Applications, Code Collaborator, Communication, Consulting, Data Warehousing (DW), Health Insurance Industry, Problem Solving, Statistical Models, Structured Query Language (SQL)
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