Senior Data Risk Adjustment Analyst; Remote

The purpose of a Sr. Data Analyst is to support the Health Services Risk Adjustment team through advanced analytics, reporting, and data-driven insights that enhance program performance and operational effectiveness. This position is responsible for developing and maintaining trusted data assets, producing meaningful analyses and reporting, and partnering with clinical, operational, financial, and technology teams to support Risk Adjustment initiatives across the organization.

Key responsibilities include analyzing program performance, monitoring key performance indicators, supporting risk score forecasting, developing member and provider targeting methodologies, creating and maintaining dashboards and reporting solutions, performing CMS, HHS, and MDH data reconciliations, and conducting ad hoc analyses to identify opportunities for improvement. The Senior Data Analyst will translate complex data into actionable insights while adhering to established data governance, compliance, and quality standards.

The ideal candidate will possess strong analytical and problem-solving skills, experience working with large healthcare datasets, and a solid understanding of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies.

We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a Care First location periodically for meetings, training and/or other business-related activities.

• Perform advanced data exploration, analysis, and solution development using programming languages and analytical tools to support Risk Adjustment initiatives. Leverage expertise across complex healthcare data structures including claims, encounters, provider, member, and risk adjustment data sources to identify trends, coding opportunities, and program improvement strategies.
• Collect, analyze, and interpret Risk Adjustment data to generate actionable insights and recommendations that improve risk score accuracy, program performance, financial outcomes, and regulatory compliance.
• Research, validate, and analyze data flow across operational and analytical ecosystems to ensure the integrity, completeness, and traceability of Risk Adjustment data used for reporting, forecasting, reconciliations, and regulatory submissions.
• Serve as a subject matter resource for Risk Adjustment analytics, supporting stakeholders with data inquiries, business questions, and issue resolution related to risk scores, coding initiatives, program performance, and regulatory reporting.
• Lead the design, development, testing, validation, and delivery of analytical solutions, dashboards, and reporting that support Risk Adjustment strategy, targeting initiatives, operational decision-making, and program effectiveness measurement.
• Partner with business and technical stakeholders to gather requirements and deliver data-driven solutions supporting Medicare, Medicaid, and ACA Risk Adjustment programs. Develop and maintain technical documentation, business requirements, data specifications, and process documentation consistent with organizational standards.

Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

Education Level: Bachelor's Degree in Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years experience in an analytical/quantitative role.