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Job SummaryThe 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.
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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.
Base Pay Range$102,000.00 - $184,300.00Exact compensation may vary based on skills, experience, and location.
Skills Required
- Bachelor's degree with 8 years experience OR Master's with 6 years OR PhD with 4 years OR 12 years relevant experience
- Proficiency querying a wide variety of internal and external data sources to derive insights
- Strong analytical skills and proficiency in computer languages such as SQL, Python, R
- Ability to create dynamic, visually engaging dashboards using Tableau or Power BI
- High degree of business intelligence and ability to take a business case from inception to execution
- Excellent communication and presentation skills
- Ability to work independently and as part of a team
- Ability to lead multiple analytic projects in parallel
- Analytics subject matter expert (Medicare risk adjustment domain knowledge expected)
- Proven performance championing initiatives and collaborating with multiple stakeholders
- Ability to work under pressure and deliver high-quality output to senior leadership on short timelines
- Deep experience with Medicare Risk Adjustment and Stars
- Advanced analytics and automation experience using Alteryx or Airflow
- Proficiency with GitHub for collaborative coding and version control
- Certification or practical experience with project management methodologies/tracking tools (Agile, Wrike, PMP) and exposure to data science in healthcare (predictive models, ML pipelines, LLMs)
Health Care Service Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Health Care Service Corporation and has not been reviewed or approved by Health Care Service Corporation.
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Retirement Support — A pension plan alongside a matching 401(k) is offered, an uncommon combination in the private sector. This combination is described as a standout element that helps retain employees.
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Healthcare Strength — Healthcare options are broad, with multiple medical, dental, and vision choices, wellness incentives, and access to resources like on-site fitness centers and an EAP. These offerings add meaningful value beyond base pay.
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Parental & Family Support — Paid parental leave (up to six weeks at full pay after one year), adoption assistance, and mothers’ rooms are available. These supports reinforce family needs alongside work commitments.
Health Care Service Corporation Insights
What We Do
Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
