• Care1st Health Plan
  • $98,985.00 -170,800.00/year*
  • Rancho Cucamonga , CA
  • Financial Services - Insurance
  • Full-Time
  • 10300 Arrow Route

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We are hiring for a Consultant data analyst position on the Commercial Risk Adjustment team.

Commercial Risk Adjustment is new to the industry (outside of Medicare Advantage), and will require deep and significant analysis, and data-mining, to help identify when a diagnosis is missing from a claims/encounter submission. This position will need to work closely with a multitude of departments, and be able to rapidly understand and navigate new situations --- and create solutions on the go.In order to create an effective team, nearly every single individual on the team needs to be extraordinarily strong in their technical background, and have the ability to learn quickly. In particular, the analyst needs to be able to lead and develop new programs and new processes while simultaneously being able to develop analytical tools to support these new programs.Consultant Data analysts need to be able to take charge and lead in situations where there is little guidance available, and still have the soft communication-skills to be able to articulate complex concepts to individuals lacking in a technical background. At the same time, their technical ability needs to be extraordinary strong as they will be working with IT to help trouble shoot any IT build-out to support these programs. Responsibilities include: -Constructing provider analytics to track care-delivery and data-completeness.

-Contributes to successful programs for the team, thru engaging multiple-areas related to provider oversight, internal cross-functional partnerships, tracking performance and measuring results.

-Leads data analysis, documenting and verifying the assumptions used in computations

-Acts as the subject matter expert in risk adjustment, regulatory and compliant requirements.

-Trains lower level analysts on how to update and apply these advanced analytic techniques.

-Responsible for executive level updates to middle-management, and coordination with other teams

-Other responsibilities as assigned.


-Requires minimum of a bachelors degree in a technical or quantitative field (GPA: 3.0+) or equivalent combination of experience and education.

-Requires a minimum of 3+ years of healthcare industry experience

- Excellent interpersonal , verbal and written communication and presentation skills especially presentations of complex, technical information to non-technical audiences. Leadership positions, public-speaking experience preferred.

- Programming experience
-Programming knowledge required. [Sample code required]
-SQL knowledge required.

- Independent problem solver , proactive, able to multitask. Patience for working on large scale problems.

- Basic proficiency with MS Office assumed (including Excel, Access, Word, PowerPoint, and Visio).

Preferred experience:
-Medicare or CommercialRisk Adjustment Experience
-SAS programming knowledge preferred.

-VBA programming knowledge preferred.
-Finance experience, including revenue and expense accounting.
-Healthcare Enrollment and Claims processing experience.
-Other healthcare experience, especially technical experience.

Physical RequirementsOffice Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork Activity level: Sedentary, frequency most of work day.

Associated topics: actuarial, actuarial director, assistant actuary, cost, director actuary, investment actuary, life actuary, model, probability, risk

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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