Quality Measurement Analyst (Analytics and Data Science, Remote)
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
· Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation. Perform data extraction, healthcare cost analysis, analytical model development, as well as production of various reports to support corporate strategies and initiatives. Execute complex analyses that guide the development of HEDIS Quality Measurement, reimbursement policy, provider negotiations, network development, value-based care, population health management, utilization management programs and other medical cost containment solutions.
1. Required Work Experience
· 1 year of experience in data analysis using analytic tools and processes (Level 1)
· 3 years of experience in data analysis using analytic tools and processes (Level 2)
· 3 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 3)
· 5 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 4)
2. Required Education
· Bachelor's Degree in mathematics, statistics, business, or related field of study (Applies to All Levels)
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
· 1 year of experience in data analysis working for a healthcare organization / health insurer (Level 1)
· 3 years of experience working for a healthcare organization / health insurer, including development of
business analytics and financial impact analyses. Experience in HEDIS, QRS and/or CMS Stars
Reporting (Level 2)
· 5 years of experience working for a healthcare organization / health insurer, including development of business analytics and financial impact analyses. Experience in HEDIS, QRS and/or CMS Stars
Reporting (Levels 3, 4)
2. Preferred Education
· Master’s Degree in mathematics, statistics, business, or related field of study. (Applies to All Levels)
3. Preferred Licenses
4. Preferred Certifications
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
· Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis in support of multiple strategic goals, mandates, and legislation
· Develop processes, write programs and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions
· Identify, analyze, interpret and validate healthcare data metrics, trends and patterns
· Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies.
· Model financial impact analyses for a variety of business initiatives
· Partner with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards
· Act as liaison to both internal business partners and external providers or vendors
· Create, modify, maintain, and enhance existing programming or business processes associated with specific responsibilities.
· Interpret, communicate, and present results to all levels of management in consistent and easy to understand formats to facilitate fact-based decision-making.
· Complete projects within preset timelines and report status to supervisor and project manager.
· Prepare written documentation on projects to provide a peer review trail and ensure continuity and integrity.
· Build and maintain close working relationships with internal stakeholders and key external client contacts (e.g. Providers, Internal Clinicians, Vendors, Customers, Brokers, BCBS Association, Blues Plans, Auditors).
· Serve as an internal analytics consultant to define business questions and transform data and analysis into meaningful and actionable information for a variety of business areas
· Perform complex analyses and interpret complex calculations to recommend actions and solutions
· Develop financial models needed to accomplish analytic goals
· Serve as subject matter expert for internal stakeholders
· Design and deliver self-service business intelligence tools to internal customers · Make sound assumptions and fact-based recommendations and discuss with supervisor, manager, or project manager.
· Effectively communicate results and recommendations to internal and external customers.
· Provide self- and peer-review of job responsibilities
· Share knowledge of skills, projects, and business needs with peers and less-experienced analysts. Train new analysts.
· Report to a supervisor or manager who provides general supervisory instructions, manages projects and reviews results. Develops own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager. LEVEL 3
· Create and research analyses and recommendations which help achieve corporate initiatives and goals
· Produce complex analytic solutions and consolidate complex analytics into easy-to-understand presentations focused on business implications
· Deliver business intelligence to clients by applying and demonstrating expertise in the areas of advanced analytics, forecasting, data extrapolation, and predictive modeling
· Communicate (both verbally and in writing) and interpret results, recommendations and abstract concepts to internal and external customers. Anticipate and address possible customer questions and concerns.
· Report to a supervisor or manager who provides minimal supervisory instructions, limited project management, and minimal or limited review of results beyond pre-release peer review.
· Train and mentor other analysts.
· Drive and implement complex and critical analytic initiatives with minimal oversight. Includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring post-implementation issues.
· Represent the department when meeting/strategizing with leadership of other areas, practicing situational awareness and balancing the business needs with prioritization of analytics resources.
· Review results post-implementation to ensure projections are realized and recommend modifications as applicable.
· Incorporate strategic planning in all areas of responsibility, collaborating with internal business partners to define and execute strategy or direction.
· Participate in leading overall strategic direction and execution of data, analytical and reporting capabilities, tools, outputs, insights and business/clinical interpretation and advisory services.
· Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
· The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
· Perform all other duties as assigned.
1. Required Job Skills (Applies to All Levels)
· Intermediate PC proficiency
· Intermediate proficiency in database, presentation, spreadsheet and word processing software
· General proficiency in mathematical concepts
· Intermediate proficiency in computer programming, including SAS and other business intelligence programs
· Intermediate understanding of data management principles
· Advanced skills in mathematics and statistics (Applies to Levels 2 - 4)
· Intermediate skill with SAS/SQL programming (Applies to Levels 2 - 4)
· Advanced understanding of data management principles (Level 3-4)
· Proficiency in SAS Enterprise Business Intelligence software (Level 3-4)
· Intermediate skill with data visualization tools, such as Tableau (Level 3-4)
2. Required Professional Competencies (Applies to All Levels)
· General knowledge of the healthcare industry
· Broad understanding of health insurance terms and concepts
· Analytical knowledge necessary to generate analytic solutions
· Ability to solve problems independently and draw accurate conclusions from data using basic analytic techniques
· Ability to deal with ambiguity and make recommendations with less than complete or conflicting information
· Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
· Ability to maintain confidentiality and privacy
· Ability to communicate effectively, both orally and in writing, to all levels in all departments
· Ability to distill and communicate financial levers and impacts to non-technical audiences
· Ability to build and maintain productive working relationships with others
· Proactive about requesting enough information to fully understand and meet the business need.
3. Required Leadership Experience and Competencies (Applies to All Levels) · N/A
1. Preferred Job Skills (Applies to All Levels)
· Advanced proficiency in spreadsheet, database and word processing software
· Intermediate proficiency with data warehouses and query tools / design
· Intermediate skill with data visualization tools, such as Tableau
· Intermediate proficiency with development, testing, and management of Tableau Dashboards
· Intermediate understanding of data management principles
· Advanced skill in database, spreadsheet, business intelligence, statistical, and data cubing software
· Familiarity with provider network design processes and strategies
· Knowledge of health benefit design and rating techniques
· Advanced skills in mathematics and statistics
· Proficiency in SAS Enterprise Business Intelligence software
· Advanced understanding of data management principles
2. Preferred Professional Competencies (Applies to All Levels)
· Project management skill needed to create timelines, track deliverables and progress, resolve issues, and
communicate project status
3. Preferred Leadership Experience and Competencies (Applies to All Levels)
· Ability to engage and collaborate with team members and business stakeholders at all levels of the organization
· Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
· High standard of performance while pursuing aggressive goals
· Principled leadership and sound business ethics
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!Apply Online
Job Status: Full Time
Job Reference #: R2990