Healthcare Statistical Analyst I – IV, VBP

• Perform technical services within the actuarial or risk adjustment department supporting Health Plan operations and financial solvency
• Monitor current data and environments and model future events
• Interact with internal and external partners and regulatory agencies
• Monitor trends and communicate opportunities and data insights
• Provide statistical information and analysis to support informed leadership decisions
• Develop and maintain analyses related to benefit designs, claims experience, Value Based Payment programs, claims savings, and risk adjustment initiatives
• Maintain reserve programs, pricing files, benefit relativity tables, trend and risk score analyses, VBP and vendor financial settlements, and ROI work
• Create and maintain technical and process documentation, data models, data mapping, and training materials
• Develop financial, claims, risk score, trend, utilization, and savings projections and unpaid claim liability estimates
• Compile and analyze data, support data quality, and provide recommendations
• Improve processes using system and software applications
• Reconcile Data Warehouse data with corporate financials or encounter submissions and develop corrective actions
• Lead or support projects, process improvements, reporting, dashboards, and strategic initiatives
• Conduct exploratory, descriptive, and inferential analysis using statistical and machine learning techniques
• Interpret regulatory changes and develop impact analyses for the Health Plan
• Collaborate with departments, stakeholders, senior leadership, and external constituents
• Travel across the Health Plan service region for meetings and/or trainings as needed

• Bachelor’s Degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science, or a relevant field required
• Level I:
  One year of related experience preferred
• Level II:
  Two years of related experience
• Level III:
  Four years of related experience
• Level IV:
  Six years of related experience
• Strong analytical skills
• Strong verbal and written communication skills
• Strong interpersonal skills and ability to collaborate with team members
• Ability to prioritize, multitask, and manage multiple simultaneous projects
• Intermediate technical skills, including proficiency in Microsoft Office Suite
• Programming skills in SQL, SAS, VBA, or similar programming language preferred; proficient programming skills preferred for Level II
• Understanding of health insurance, health insurance products, managed care, accounting principles, competitive markets, legislative environments, and regulatory issues affecting Health Plans (Level II)
• Ability to work independently and motivation to improve processes (Level II)
• Understanding of non-Actuarial functions and their effects on Health Plan operations and financials (Level II)
• Ability to perform complex modeling independently (Level III)
• Ability to recognize and automate repetitive tasks (Level III)
• Ability to communicate analytical findings at the appropriate level of detail (Level III)
• Experience leading projects or process improvement initiatives (Level III)
• Ability to write and communicate complex concepts (Level III)
• Advanced understanding of non-Actuarial functions and their effects on Health Plan operations and financials (Level IV)
• Advanced ability to independently communicate analytical findings (Level IV)
• Ability to write, communicate, and present complex concepts to actuarial and non-actuarial audiences (Level IV)
• Ability to work at a workstation using a computer, keyboard, mouse, and/or phone for three or more hours at a time
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed

Demonstrates strong analytical capabilities and proficiency in statistical analysis, data modeling, and financial projections within the health insurance sector. Effectively communicates complex concepts to diverse audiences and collaborates with stakeholders to drive process improvements and strategic initiatives.

• Statistical Analysis
• SQL Programming
• Data Modeling
• Health Insurance Knowledge
• Project Leadership

• Statistical Analysis
• Data Modeling
• Financial Projections
• SQL Programming
• SAS Programming
• VBA Programming
• Data Mapping
• Trend Analysis
• Risk Score Analysis
• Claims Experience Analysis

• Strong Analytical Skills
• Verbal Communication
• Written Communication
• Interpersonal Skills
• Collaboration

• Health Plan Operations
• Risk Adjustment
• Value Based Payment
• Managed Care
• Regulatory Compliance
• Benefit Design
• Claims Savings
• Financial Solvency

• Microsoft Office Suite
• Data Warehouse
• Statistical Software
• Machine Learning Techniques