Medical Informatics Analyst, Senior

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!


Job Summary

To deliver on the commitment in our mission, Blue Shield has established innovative partnerships with providers across the state focusing on improved member experience and transformational healthcare. A large component of our mission is affordability and driving cost of healthcare (COHC) savings strategies based on Accountable Care Organizations (ACO's). ACO's are geographically-based risk-sharing arrangements between Blue Shield and providers.

  • Provide analytic support to facilitate the administration of Blue Shield's provider partnerships and risk share arrangements.
  • Will be required to understand the core BSC business strategy, including all aspects of implementing a value based care program, and to think outside the box to proactively deliver creative solutions.
  • Will be the key leader diving BSC risk share arrangement negotiations and provider partnerships working directly with internal and external executive leadership.
  • Maintain and enhance financial models used to evaluate provider risk share participation and performance, and support contractual negotiations.
  • Extract claims data and construct financial analyses to support the creation, maintenance, and optimization of Blue Shield's provider partner support tools.
  • Ability to produce adhoc performance reports of medium to high complexity under tight deadlines.
  • Apply appropriate technical, clinical, and financial knowledge to assess the completeness and reliability of data and the validity/accuracy of analytical results.
  • Analyzes, prepares, and summarizes recommendations for risk share financial modeling, experience dashboards, healthcare cost trend, annual risk share financial reconciliation, attribution model summaries, and provider presentation development.
  • May perform healthcare research and application to include expense/revenue, hospital reimbursement, physician reimbursement, population attribution, and health risk adjustment.
  • Looking for a candidate who are passionate about paving a road to the future of healthcare delivery on a fun and engaging team.


Knowledge and Experience
  • Typically, requires a college degree or equivalent experience and minimum 5 years of prior relevant experience.
  • Competencies: Must be able to develop novel computer programs and scripts using Base SAS and PL-SQL. Must be able to develop programs and scripts that can be passed on to other analysts to improve their work efficiency.
  • Must be able to calculate multivariate statistics and to prepare complex statistical graphics (star plots, diagnostic regression plots, etc.).
  • Requires accomplished knowledge of clinical risk adjustment, burden of illness scoring, episode analysis.
  • Requires 3-5 years' experience in Health Care (managed care, academic, or gov't payer). Typically has experience in cost-of-healthcare or quality of care assessment in a managed care or academic setting.
  • Typically, requires advanced knowledge of health data science typically obtained through advanced education combined with experience. May have practical knowledge of project management.
  • Proven strong technical skills with SAS, SQL, Excel VBA, and/or other languages (R, Python, etc.). Tableau experience is a plus.
  • Knowledge and application of healthcare data analysis principles, concepts and standards.
  • Strong verbal and written communication skills.
  • Strong analytical and presentation skills and strategic mindset.
  • Proven ability to work independently and be a self-starter with minimal direction and creative problem-solving skills.
  • Have a strong desire to work in healthcare provider partner innovation.
  • Actuarial background is a plus, but not required.

Physical Requirements

Office 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.
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External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.EEO Policy