Senior Consultant, Quality & Risk Adjustment Analytics

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Serves as a senior analytical thought partner to Population Health & Quality leadership, providing independent analytical expertise across Quality and Risk Adjustment. Combines deep healthcare performance knowledge with advanced hands-on analytical capabilities to independently access, integrate, validate, and analyze complex healthcare data and translate findings into actionable business insights. Identifies trends, performance drivers, emerging risks, and opportunities across Quality and Risk Adjustment and conducts analyses to determine underlying causes and business implications. Develops clear, decision-oriented reporting and recommendations for executive and cross-functional stakeholders. Works across business, clinical, provider, financial, operational, and analytics partners to strengthen performance intelligence and support enterprise decision-making. Performs other duties as assigned.

Key Accountabilities

• Healthcare Performance Analysis & Insights
  • Independently analyzes Quality and Risk Adjustment performance to identify meaningful trends, variation, emerging risks, and improvement opportunities
  • Conducts root-cause, variance, cohort, provider, member, market, and other analyses to determine key drivers of performance
  • Integrates Quality and Risk Adjustment data and perspectives to identify relationships and performance signals that may not be visible when the domains are evaluated independently
  • Evaluates results in the context of business objectives, regulatory requirements, provider performance, member outcomes, and financial implications
  • Develops hypotheses, tests potential explanations, and distinguishes meaningful performance signals from normal variation or data anomalies
  • Proactively identifies issues and opportunities requiring additional investigation or leadership attention

• Executive Reporting, Interpretation & Decision Support
  • Translates complex analytical findings into clear business implications, risks, opportunities, and recommended actions
  • Develops executive-level reporting and analyses that explain what changed, why it matters, key drivers, and where intervention or additional investigation is warranted
  • Serves as an analytical thought partner to the Vice President, Population Health & Quality and other senior leaders
  • Presents complex findings to technical and non-technical audiences in a clear, concise, and decision-oriented manner
  • Develops and monitors meaningful performance indicators and identifies changes requiring leadership attention
  • Supports strategic planning, forecasting, performance reviews, business cases, and other executive decision-making through targeted analysis
  • Challenges assumptions and reported results when underlying data or observed performance warrants additional investigatio

• Cross-Functional Performance Partnership
  • Partners across Quality, Risk Adjustment, Population Health, Provider, Clinical, Finance, Operations, Analytics, Technology, and other functions to support enterprise performance improvement
  • Provides subject matter expertise related to Quality and Risk Adjustment data, measurement, performance, and analytical interpretation
  • Helps stakeholders translate business questions into appropriate analytical approaches and actionable measures
  • Promotes consistent definitions, analytical rigor, data transparency, and effective use of performance information
  • Identifies opportunities to improve analytical processes, tools, data accessibility, and organizational performance intelligence

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 8+ years of applicable experience in healthcare analytics, health insurance, Quality, Risk Adjustment, healthcare performance, or a related field.

Preferred Qualifications

• Demonstrated experience analyzing healthcare performance across Quality, HEDIS, Stars, Risk Adjustment, or closely related health plan performance domains.

• Demonstrated ability to independently interpret complex healthcare data and identify trends, performance drivers, risks, and opportunities.

• Advanced SQL skills with demonstrated experience independently querying, joining, validating, and analyzing large and complex datasets.

• Experience using Python, R, or comparable analytical programming tools for healthcare data analysis.

• Experience working with healthcare data including claims, encounters, membership, provider, clinical, Quality, or Risk Adjustment data.

• Demonstrated experience conducting root-cause, trend, variance, cohort, and performance-driver analyses.

• Demonstrated ability to translate complex analytical findings into clear business insights and recommendations for senior leadership.

• Strong understanding of healthcare performance measurement and the relationship among clinical performance, provider performance, member outcomes, regulatory requirements, and financial performance.

• Demonstrated ability to work independently on complex, ambiguous analytical questions and determine the appropriate analytical approach.

• Strong communication, critical-thinking, problem-solving, and executive presentation skills.

• Demonstrated ability to partner effectively across business, clinical, technical, financial, and operational stakeholders.

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office, on average, 3 days per week.

The full salary grade for this position is $115,400 - $197,800. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $115,400 - $156,560. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.