Job Description

This role is responsible for providing advanced analytical support for ACA risk adjustment, including data collection, model implementation, trending, forecasting, validation, reporting, and financial reconciliation. The Senior Insights Analyst will serve as a primary analytical resource for ACA risk adjustment activities, prepare and interpret complex data for internal and external customers, investigate discrepancies across data sources and systems, and translate findings into clear business insights. The role will partner closely with Actuarial, regulatory submission, value-based program, vendor, and operational stakeholders while helping improve analytical controls, documentation, automation, and recurring processes.

Role Focus: Primary analytical ownership for ACA risk adjustment, including model implementation, RAF validation, regulatory analytics, financial reconciliation, discrepancy analysis, and stakeholder support.

What You'll Do

• Use analytical and reporting tools, including SQL, Python, and other approved platforms, to efficiently access, investigate, validate, and analyze complex healthcare data.

• Develop, analyze, report, and interpret complex data for ongoing activities and projects while ensuring outputs are accurate, documented, and available within established deadlines.

• Support ACA risk adjustment model implementation, testing, validation, and recurring member-level RAF score production.

• Perform in-depth trend, variance, and root-cause analysis to explain changes in risk scores, transfer estimates, regulatory submission results, and provider settlement outputs.

• Reconcile outputs across analytical processes and source systems, identify discrepancies, and coordinate issue resolution with business, technical, and operational partners.

• Support and manage complex analytical applications across multiple platforms and coordinate code migrations and changes between application environments.

• Maintain and coordinate existing cross-functional programs and develop new analytical processes, controls, reports, and tools that improve accuracy, repeatability, and transparency.

• Engineer efficient report-generation processes by optimizing back-end data ingestion, manipulation, profiling, validation, and documentation.

• Work collaboratively with customers to complete effective analyses and provide analytical support and problem-solving assistance to business areas.

• Identify complex trends and make actionable recommendations that assist business partners with financial, operational, regulatory, and strategic decision-making.

• Present findings, risks, and recommendations clearly to technical and non-technical audiences, including all levels of leadership.

• Represent the department on cross-functional project teams and process optimization efforts that require analysis, interviews, procedure design, documentation, and implementation.

• Coordinate analytical support for external vendor engagements and validation activities, as assigned.

• Ensure appropriate security and privacy for data containing protected health information and resolve identified security or privacy concerns in accordance with company requirements.

• Provide ongoing user support for ad hoc reporting, questions, data inquiries, and analytical problem resolution.

• Serve as a mentor or coach for less experienced employees and contribute to cross-training and knowledge continuity.

What You Have

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

Bonus Points

• Experience with healthcare analytics, preferably ACA commercial risk adjustment, HHS risk adjustment models, EDGE data or submissions, or related regulatory analytics.
• Advanced SQL skills and experience using Python or comparable analytical tools to develop, validate, and maintain complex, repeatable data processes.

• Demonstrated ability to validate member-level risk scores or other financially significant outputs, reconcile results across systems, and perform root-cause analysis of discrepancies.

• Experience translating complex results into clear insights for Actuarial, Finance, regulatory, operational, or provider-facing stakeholders.

• Experience supporting recurring processes with overlapping deadlines and high accuracy requirements, including creating documentation, controls, peer-review routines, and process improvements.

• Ability to independently lead analytical work, coordinate across cross-functional teams and external vendors, communicate risks and recommendations, and operate effectively with limited supervision during critical business cycles

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community 

• Work-life balance, flexibility, and the autonomy to do great work 

• Medical, dental, and vision coverage along with numerous health and wellness programs 

• Parental leave and support plus adoption and surrogacy assistance 

• Career development programs and tuition reimbursement for continued education 

• 401k match including an annual company contribution 

• Learn more 

Where You’ll Work

Our Hybrid-Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote-Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid-Flex or Remote-Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$98,092.00 - $156,947.00

Skills

Analytical Analysis, Data Analysis, Data Analysis Reporting, Data Analytics, Data Engineering, Data Governance, Data Mining, Data Science, Identifying Trends, Trend Analysis

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at HR.Staffing@bcbsnc.com.

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming