Medical Informatics Analyst, Consultant

4 weeks ago

Oakland CA, Alameda County, CA, United States Blue Shield of California Full time

Your Role

The Blue Shield of California Growth and Servicing analytics organization is part of the centralized Data and Analytics organization and oversees Channel Analytics including Digital, Marketing, Claims, Appeals, Grievances, Disputes and Line of Business. The role of Medical Informatics Analyst – Consultant would report to the Manager of Medical Informatics and would be responsible for supporting the growth and retention of members in the Individual & Family Plan (IFP) Line of Business. You will have a strong understanding of the various IFP products and excited about improving the member health outcomes through data & analytics as you engage directly with stakeholders to help frame business problems, participate in recommending analytic frameworks to address those problems and deliver high quality/high impact solutions. On top of having a product-oriented mind set, the ability to influence & impact outcomes in a matrixed environment are essential to being successful in this role.

Your Work

In this role you will:

  • Analytics & Modeling: Perform in-depth membership & claims analyses and models to understand and predict member behavior, changes in trends, and uncover actionable insights to improve member acquisition, engagement, health, retention, and experience.
  • Data Profiling & Reporting: Utilize appropriate tools to analyze large datasets, focusing on membership, claims & revenue along dimensions such as broker & provider performance related to BSC’s Individual Market product administered through California Health Exchange (Covered California) and direct sales.
  • Analyze structured and unstructured data to uncover pain points, establish causality/identify the root causes and recommend and size improvements for prioritization.
  • Build reports and dashboards to empower stakeholder decision making.
  • Be enthusiastic about figuring out how to attract new members, keep existing members, deepen our relationships with members, serve them efficiently, keep them healthy and ensure they have a great experience.
  • Enjoy solving thorny problems and developing data-driven solutions.
  • Thrive in a highly matrixed environment.

Your Knowledge and Experience

  • Bachelor’s degree in data science, health informatics, statistics, mathematics, economics, engineering or related quantitative fields. Master’s degree preferred
  • 7+ years working with Claims and Membership, or similar data a huge plus.
  • Requires working knowledge of Snowflake, Databricks, RDBMS (Oracle, Netezza etc.)
  • Advanced SAS, SQL, Python skills to interact with data,
  • Tableau skills to create reports and visualization.
  • Knowledge of HEDIS & experience in supporting the California Health Exchange.
  • Ability to partner enthusiastically with all levels of staff and adapt quickly to shifting and/or competing priorities.

Pay Range:
The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Notes:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

#LI-FB1

  • Medical Informatics Analyst, Consultant

    1 month ago

    Oakland, CA, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Cost of Healthcare Trendsetters & Pharmacy Support team analyzes and provides emerging healthcare cost trend drivers. The Medical Informatics Analyst IV will report to the Actuarial Manager. Your Work In this role, you will: Conduct independent analysis of high complexity under minimal supervision and guidance Develop analytical...

  • Medical Informatics Analyst, Principal

    2 weeks ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Data & Analytics (D&A) team focuses enterprise-wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data-driven solutions to accelerate business outcomes. The Medical Informatics Analyst, Principal will report to the Senior Manager, Medical Informatics (Value Based and Medical Care...

  • Medical Informatics Analyst, Principal

    5 days ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Data & Analytics (D&A) team focuses enterprise-wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data-driven solutions to accelerate business outcomes. The Medical Informatics Analyst, Principal will report to the Senior Manager, Medical Informatics (Value Based and Medical Care...

  • Risk Adjustment Consulting, Consultant

    1 month ago

    Oakland, CA, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The ACA Chart Program team conducts the following functions (1) identify medical records with unreported diagnosis codes, (2) retrieve those medical charts, (3) perform medical coding to convert them into risk adjustable diagnosis codes, and (4) submit to CMS via the EDGE pathway. The Risk Adjustment, Consultant will report to the Senior Manager....

  • Business Systems Analyst, Consultant

    2 weeks ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Platform Strategy and Operations Team is focused on optimizing Salesforce solutions and maximizing value across the enterprise. Salesforce is an enterprise platform targeted to help accelerate our transformation program, enable innovation, and help realize our vision for a reimagined healthcare system. Our team works cross-functionally to link...

  • Risk Adjustment Consulting, Consultant

    4 days ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Blue Shield’s Risk Adjustment (RA) team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us to deliver industry-leading results. The RA team is looking to improve operational coordination...

  • Risk Adjustment Consulting, Senior

    4 days ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The ACA retrospective chart team develops suspecting logic to determine unreported diagnosis in medical charts, tracks retrieval, coding, QA of charts, perform ad hoc analytics to help team monitor expected value of each chart chase and determine drivers of performance.. The Risk Adjustment senior will report to the Sr Manager. In this role you...

  • Application Developer, Consultant

    2 weeks ago

    Oakland, California, 94616, Alameda County, CA, United States Blue Shield of California Full time

    Your Role With pharmacy benefits being an essential component of the medical benefits, Pharmacy Care Reimagined is a critical Blue Shield of California initiative along with other Health Care Reimagined initiatives. The Pharmacy Care Reimagined goal is to enable every person with safe, equitable access to sustainably affordable prescription drugs. To enable...

  • Clinical Quality Analytics, Senior

    1 week ago

    Oakland, California, Alameda County, CA, United States Blue Shield of California Full time

    Your Role The Clinical Quality Analytics and Informatics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, and regulatory reporting. The Clinical Quality Analyst - Senior will...

  • Financial Analyst, Consultant

    1 month ago

    El Dorado Hills, CA, 95762, El Dorado County, CA, United States Blue Shield of California Full time

    Your Role The Corporate Services Finance team ensures financial stewardship of the Corporate Services administrative budget and serves as the trusted financial advisor to executive leadership. Our team is looking for a Financial Analyst, Consultant to steer financial performance toward Blue Shield goals. The position will support annual planning, monthly...

  • Nurse Practitioner II

    3 weeks ago

    Oakland, California, 94617, Alameda County, CA, United States Kaiser Part time

    Job Summary: The Nurse Practitioner (NP) is responsible for the assessment of selected patients in the designated service. The NP performs physical examinations, confers with patients in person and by phone/electronically, collaborates with others in the department to assure smooth flow of patient care consistent with established quality indicators and...

  • Nurse Practitioner II

    1 week ago

    Oakland, California, 94617, Alameda County, CA, United States Kaiser Part time

    Job Summary: The Nurse Practitioner (NP) is responsible for the assessment of selected patients in the designated service. The NP performs physical examinations, confers with patients in person and by phone/electronically, collaborates with others in the department to assure smooth flow of patient care consistent with established quality indicators and...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Part time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of...

  • Clinical Nurse II

    3 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Part time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    4 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of independently...

  • Clinical Nurse II

    3 weeks ago

    Oakland, California, California, 94617, Alameda County, CA, United States Alameda Health System Full time

    Summary SUMMARY: Under general supervision, provides nursing care to patients, including medications and treatment. Plans, implements, and evaluates patient care and performs related duties as required. The CN II level is the journey level class where incumbents have had the required professional nursing experience and are capable of...