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“Commercial Analytics” area is comprised of the below three core teams:


Risk and Care Analytics
  • Provides analytical support and insights to drive strategy, ensure compliance, and evaluate effectiveness of revenue program initiatives and campaign operations in support of the Affordable Care Act (ACA) Risk Adjustment program
  • Conducts analysis to support clinical care operations (medical and pharmacy), customer segmentation, and actionable results and insights that improve the health of our members
Provider Performance
  • Provides analysis in support of provider contracting strategies/negotiations and financial performance including impact of network acquisitions, terminations, and contractual arrangements
  • Examines and monitors provider performance and trends in support of forecasting, pricing, and product development
Value Based Providers
  • Develops analytics to drive opportunities on alternative payment programs or value based programs, including but not limited to Accountable Care Organization’s and Patient Centered Medical Homes
  • Negotiates/Develops contracts, report on arrangements, and support provider relationships in support of forecasting, pricing, and product development
The Data Consultant will develop analyze and provide insight, analysis and reports. In this role you will be accountable for identifying and quantifying key drivers for the Health Business, investigating areas of opportunity, evaluating effectiveness and making recommendations. You will assist the leadership team in evaluating key business drivers. Utilizing strong analytics, technical and communication skills, as well as having deep broad understanding of the business to summarize key findings. This role also serves as a lead on projects and assists other team members by reviewing work, providing training and technical guidance.
The Skills You Bring
  • 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.
  • 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. Provide guidance and review work of team members.
Required Skills:
  • 6+ years related work experience or equivalent combination of transferable experience and education.
  • Experience using algorithms and inferential statistics.
  • Advanced level experience writing SQL /SAS or related code
  • Advanced Excel skills
  • Experience with health business
  • Bachelor’s degree or equivalent work experience
  • Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
  • Mastery of communicating highly complex information clearly and articulately for all levels and audiences
Preferred Skills:
  • Bachelor’s degree Business Analytics, Health Economics or similar program
    Master’s degree in a related field
  • Experience using risk adjusters

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