Principal Health Business Analytics - Risk Adjustment

Job Summary:

The Principal, Health Business Analytics leads analytic strategy and execution for Medicare Risk Adjustment programs, driving insights that optimize revenue, compliance, and operational performance. This role partners with cross-functional leaders to translate complex data into actionable strategies that improve risk score accuracy, evaluate program effectiveness, and support executive decision-making. The Principal Health Business Analyst applies expertise to initiatives of the highest risk, complexity and impact to the business, solves the most critical issues, serves as a strategy influencer, applies knowledge of emerging trends and industry practices and is responsible for coaching, training and providing technical oversight to others.

Essential Functions:

• 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.
• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• 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

Required Work Experience
8+ years related work experience. Experience Details: Risk Adjustment
Related Bachelor's degree or additional related equivalent work experience
Experience using algorithms and inferential statistics.
Advanced level experience writing SQL /SAS or related code
Advanced Excel skills
Proficient with Microsoft Office products
Ability to manage tasks independently, take ownership of responsibilities and meet deadlines
High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy
Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
Ability to train team members on advanced analytical tools and techniques (complex SAS and/or SQL, advanced Excel and detailed risk/analytical models)
In-depth business process knowledge of several key business functional areas
Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences
Expert innovator with ability to think beyond established standards and processes
Expert-level knowledge and experience applying current and emerging trends
Expert consulting, negotiating, communicating , consensus building, presentation and facilitation skills
4 or more years of experience with health business

Preferred Education
Bachelor's degree Business Analytics, Health Economics or similar program
Master's degree

General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $116,500 - $189,300

Typical Annualized Hiring Range: $116,500 - $145,600

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.