Senior Risk Adjustment Analyst

Anticipated End Date:

Position Title:

Job Description:

Location: Norfolk VA, Mason OH, Indianapolis IN, Louisville KY, Grand Prairie TX, Tampa FL, Atlanta GA

Hours: Standard Working hours

Travel: This role requires associates to be in-office 1 – 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Position Overview:

The Senior Risk Adjustment Analyst is a high-impact individual contributor on Elevance's Medicare Advantage Risk Adjustment team, reporting directly to the Staff VP of Analytics/Decision Support. This role is responsible for conducting advanced data analysis, building and maintaining HCC performance reporting, supporting predictive modeling initiatives and monitoring vendor performance. The Sr. Analyst serves as a key analytical resource, translating complex data into actionable insights for both clinical and operational stakeholders.

How You Will Make an Impact:

• Design, develop, and maintain risk adjustment performance dashboards and reports using Power BI, Tableau, or equivalent tools to monitor KPIs

• Write and optimize complex SQL queries to extract, transform, and analyze large datasets from data warehouses and payer/provider data systems

• Support the development and validation of predictive models for HCC suspecting, risk score forecasting, and provider performance stratification

• Prepare and present analytical findings, trend analyses, and performance summaries to key internal stakeholders

• Mentor junior analysts and coordinators, providing guidance on analytical methods, data interpretation, and risk adjustment concepts

• Support cross-functional initiatives in quality, population health, provider engagement and finance as they relate to risk adjustment analytics

• Maintains active relationships with customers to determine business requirements, leads requirement meetings

• Proactively addresses customer issues, prepares alternatives and implements solutions

• Collaborates with engineers for creative ideas for supporting interactive content, analyzes and classifies complex change request and reviews and evaluates possible enhancements

• Identifies and manages risks and develops contingency plans

• Partners with business, architecture and infrastructure and oversees all service levels

• Develops and defines application scope and objectives, including impact to interfaces

• Analyzes and evaluates detailed business and technical requirements

• Mentors others on coding standards and performs code reviews

• Supervises others on developing application internals for usability, reliability and scalability requirements

• Ensures system testing is completed and meets the test plan requirements

• Coordinates integration activities with other IT to ensure successful implementation and support of project efforts

• Assesses current status and supports BI planning efforts

• Mentors and assists in training initiatives and performs estimates for costs and impacts

• Manages small to medium projects, potentially leading global projects

• Mentors and provides training, conducts vendor evaluations and manages pilots for Business Intelligence tool upgrades

Required Qualifications:

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and minimum of 5 years experience with multi platform, two or more BI applications and/or multiple Business Intelligence tools required; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

• Medicare Advantage or commercial Risk adjustment data analysis experience is a must have

• SQL experience strongly preferred

• Intermediate Excel experience preferred

• Power BI experience is nice to have

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.