Risk Adjustment 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 Description

Risk Adjustment Analyst, Senior - In-Home Visits This position is part of the Blue Shield Risk Adjustment team within Finance Department and will work within a team to s upport the In-Home Visit (IHV) Program. The Analyst will provide essential analytical support to ensure success of the IHV program including tracking of performance metrics against goals and providing actionable insights into variances to goals.

To create an effective team, every individual must have:
  • The desire to support Blue Shield Promise's missions, goals and the member population which we serve.
  • Excellent interpersonal/communication skills across various media (written, verbally in meetings and over-the-phone)
  • The ability to engage and collaborate with others in a team setting to successfully complete projects
  • The ability to prioritize and manage projects/timelines to achieve successful outcomes
  • detail-oriented
  • Have strong analytical skills
  • The ability to work in a fast-paced environment with dynamic work demands
  • Track In-home visits performance metrics (weekly) by vendor against goals
  • Production of IPA Reporting packet/reporting suite (weekly)
  • Calculation of ROI (monthly) by In-home visit vendor
  • Data reconciliations (weekly/monthly)
  • Member incentive processing
  • Invoice reconciliations and processing
  • Outreach list creation and coordination of refreshes
  • Analytics to improve outreach identification
  • Data submission


  • Requires minimum of a Bachelor's degree in a technical or quantitative field
  • At least 3 years of healthcare experience, with at least 2 years in a data analysis role
  • Excellent interpersonal, verbal and written communication and presentation skills - especially presentations of complex, technical information to non-technical audiences and from non-technical information to technical information
  • Independent problem solver, proactive, able to multitask. Patience for working on large scale problems.
  • Proficient in SQL / SAS and other data/analytic tools
  • Proficient with MS Office (Excel, Word, PowerPoint and Visio)
  • Knowledge of healthcare management in Provider Relations, Contracting, Member Enrollment, Claim Process, Medical Payment and Revenue Reporting, and Encounter submissions and measures
  • Commercial or Medicare Risk Adjustment experience

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.
Please click here for further physical requirement detail.

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