Risk

• Lead analytic strategy for risk adjustment and align insights with enterprise financial and compliance goals.
• Analyze risk score trends, model performance, and program results to identify revenue and quality improvement opportunities.
• Partner with Finance and Actuarial to forecast revenue and assess CMS model impacts (e.g., V24 → V28).
• Evaluate vendor, provider, and campaign performance for prospective, retrospective, and encounter programs.
• Ensure analytic integrity, data accuracy, and compliance with CMS risk adjustment requirements.
• Deliver clear, actionable insights and visualizations to senior leadership.
• Mentor analysts and advance the use of predictive modeling, automation, and performance dashboards.
• Serve as strategy influencer and subject matter expert on assigned projects of high risk, complexity and impact to the business.
• Manipulate data using large datasets and multiple data sources.
• Act as primary Analyst for large projects and proactively identify topics for analysis.
• Analyze or assist in the analysis of processes and programs in achieving stated goals. Provide analyses and recommendations if corrections are needed. Investigates and discovers areas of opportunity.
• Develop advanced Excel-based models and spreadsheets containing advanced functions that are used to evaluate historical trends and forecasts and to identify best practices.
• Write advanced SAS and/or SQL programs for data extraction. Integrate data across multiple areas. Modifies existing programs for data extraction.
• Apply risk adjusters when applicable.
• Accountable for developing insightful and actionable summaries and recommending actions.
• Monitor and evaluate patterns, costs and trends.
• Recommend new analytical processes; partner with Information Management in the development of new analytical tools such as power pivots and analytical cubes to enhance analytical capabilities.
• Train team members on analytical tools and techniques including complex SAS and/or SQL, advanced Excel and detailed risk/analytical models. Provide guidance and review work of team members.
• Monitor emerging trends, provides strategy input to Director, prepares benchmarking reports and recommendations.
• Lead development of industry leading analytical methods, tools and models.

Principal Health Business Analytics – Risk Adjustment

Risk Analyst – Casualty

Employee Benefits, Risk Advisor

Risk Advisor – Employee Benefits

PRN Nurse Practitioner – Per Visit Health Risk Assessments

Risk Strategist