Senior BI Engineer- Medicaid Value Programs

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The Senior Business Intelligence Engineer describes the tools, technologies, applications and practices used to collect, integrate, analyze, and present an organization's raw data to create insightful and actionable business information. Makes an impact to the department's strategy. Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Generates ad hoc reports and regular datasets and/or report information for end-users using queries and scripts to inform value-based payment (VBP) model design and administration. Create technical specifications for reports based on business requests.

This position will report to the Associate Director, Value-Based Programs.

• Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
• Analyze utilization data to reconcile provider disputes.
• Design and contribute to the development of the provider reporting packages to help providers understand their overall performance.
• Contribute to the development of data models to attribute members to providers for new and enhancements to existing value-based programs and to evaluate program effectiveness
• Perform quality assurance checks with peers and lead Business Intelligence associates to ensure development of the program meets business requirements
• Partner with finance team to conduct impact analysis and modeling for new VBP models.
• Collaborate with cross functional and matrixed teams to operationalize and roll out new VBP models.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
• Design and develop Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, etc.
• Ensure data integrity in program administration for new value-based programs
• Troubleshoot data integrity issues and offer solutions to solve challenges

• Bachelor's degree
• 5 or more years of technical experience in data analysis OR Master's degree and 3 or more years of experience in data analysis
• Advanced in SQL, SAS and other data systems
• Experience with tools such as Power BI and DAX language for creating data visualizations
• Proficiency in verbal and written communication to senior and executive leadership
• Advanced experience working with big and complex data sets within large organizations
• Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
• Comprehensive knowledge of Microsoft Office Applications including Word, Excel, Access and Power Point
• Strong organizational skills and ability to manage multiple or competing priorities
• Proficiency in understanding Healthcare related data
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Strong attention to detail

• Medicaid and Medicaid managed care experience
• Experience performing claims data analysis to inform VBP model design
• Advanced Degree in quantitative disciplines, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field
• Expertise in data mining, forecasting, simulation, and/or predictive modeling
• Create analytics solutions for various healthcare sectors

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using exciting interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a Hire Vue interview. In this interview, you will receive a set of interview questions over your phone, and you will provide…