CareFirst Careers

Stars & Risk Adjustment Analyst

Resp & Qualifications

PURPOSE
Interprets Stars rating data; analyzes HEDIS, CAHPS and Stars results using statistical techniques; and provides ongoing reports.  Executes quantitative analyses that translate data into actionable insights.  Provides analytical and data-driven decision-making support for key projects.

ESSENTIAL FUNCTIONS
Weight Essential Functions
Collect, analyze, and interpret Stars data to glean insights, and develop business recommendations for improvement.

Develops and automates reports, solving for the Business Intelligence (BI) and analytical needs of full range of stakeholders. Works with stakeholders to establish the right metrics for monitoring the business.

Uses the latest CMS & NCQA requirements and works with stakeholders and engineering colleagues to help deliver data driven solutions.

Communicates findings on a regular basis to all levels of business and management.

Reviews reports and performance indicators to improve quality and Stars ratings.

Sets standards for data management and conceives projects needed to eliminate the gap between current state and future goals. Assists in defining and driving standards for data management and delivers projects needed to eliminate the gap between current state and future goals.


SCOPE

People Management
# of Direct Reports:
# of Indirect Reports:
Individual Contributor Details


Freedom To Act
Work is accomplished with limited direction.  Determines and develops approach to solutions.  Work is evaluated upon completion to ensure objectives have been met.

Problem Complexity and Problem Solving Timeframes
Provides resolution to an assortment of problems that are typically well defined,  but some clarification or judgment is required to determine action, as additional information about the problem / task is discovered.  Uses judgment within defined practices / procedures to determine appropriate action.  Problem/Task resolution timeframe: Inclusive of shorter timeframes, but the majority of tasks take up to several weeks to resolve.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: Bachelor's Degree
Education Details: Data Science, Mathematics, Computer Science, Statistics, Business or related field
Experience: 2 years of post-college work in a quantitative role, 4 years of relevant work experience is required in addition to the required work experience.

Preferred Qualifications
Hands on experience with Big Data/NoSQL Platforms with experience delivering production projects at scale.
Experience with HEDIS, CAHPS, and Stars

Knowledge, Skills and Abilities (KSAs) Proficiency
Strong quantitative and qualitative skills. Proficient
Knowledge and understanding of analytical tools, such as SAS, Excel, SQL. Proficient
Excellent communication skills both written and verbal Proficient
Ability to learn quickly and take direction. Proficient

Additional Skills and Abilities
Proven track record of turning data into meaningful analysis, presenting to business stakeholders, and driving value for the business. Ability to see the big picture and to focus on details when necessary. Advanced knowledge and experience in topics of data and information management.



 

Department

Department:

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

PeopleSoft/Self Service/Recruiting

Closing Date

Please apply before: 1/30/21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Physical Demands N/A Rarely Occasionally Frequently Constantly Weight
Standing X
Walking X
Sitting X
Lifting X 20 lbs
Carrying X 20 lbs
Pushing X 20 lbs
Pulling X 20 lbs
Climbing X 20 lbs
Balancing X
Stooping X
Kneeling X
Crouching X
Crawling X
Reaching X
Handling X
Grasping X
Feeling X
Talking X
Hearing X
Repetitive Motions X
Eye/Hand/Foot Coordination X
Working Environment N/A Rarely Occasionally Frequently Constantly
Extreme cold X
Extreme heat X
Humidity X
Wet X
Noise X
Hazards X
Temperature Change X
Atmospheric Conditions X
Vibration X

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Business Operations