Senior Health Care Analyst - Program Performance

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI (Hybrid)

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: position summary,position details,healthcare analytics & performance measurement,provider, and cohort contract reconciliation,dashboards, reporting & data visualization,strategic analysis & problem resolution,healthcare,leadership,innovation & continuous improvement,education,experience,technical skills,professional skills

Non-Manager

Competitive Total Compensation Package

Overview: <p>Responsible for planning, organizing, directing, and executing complex analytical initiatives that support Health Care Value programs and performance management activities. This position operates with a high degree of independence and is responsible for researching, analyzing, and interpreting healthcare data to identify trends, evaluate program performance, quantify savings, and provide actionable business recommendations.</p> <p>The Senior Healthcare Analyst partners with internal stakeholders, vendors, providers, and leadership teams to develop analytical solutions, monitor contractual performance, and deliver strategic insights that improve healthcare affordability, quality, and operational effectiveness.</p>
Responsibilities: <p><strong>Healthcare Analytics &amp; Performance Measurement</strong></p> <ul> <li>Lead the research, analysis, and evaluation of healthcare claims, authorization, utilization, provider, and membership data to identify trends, risks, and opportunities.</li> <li>Develop appropriate utilization baselines, benchmarks, and unit cost methodologies to support performance measurement and financial validation activities.</li> <li>Perform complex analyses to evaluate healthcare programs, vendor performance, provider initiatives, and value-based care arrangements.</li> <li>Deliver actionable insights and recommendations that support strategic decision-making and operational improvements.</li> </ul> <p><strong>Vendor, Provider, and Cohort Contract Reconciliation</strong></p> <ul> <li>Provide monitoring and reconciliation support for vendor risk and performance contracts.</li> <li>Provide monitoring and reconciliation support for provider risk and performance contracts.</li> <li>Provide monitoring and reconciliation support for cohort and population-based performance arrangements.</li> <li>Quantify savings, utilization impacts, and financial outcomes in accordance with contractual methodologies and statements of work.</li> <li>Collaborate with internal and external partners to investigate variances, validate results, and resolve discrepancies.</li> </ul> <p><strong>Dashboards, Reporting &amp; Data Visualization</strong></p> <ul> <li>Develop, maintain, and enhance Tableau dashboards and other reporting solutions that support organizational performance monitoring.</li> <li>Gather stakeholder requirements and continuously improve dashboards based on business needs and user feedback.</li> <li>Create executive-level reports, presentations, scorecards, and performance summaries.</li> <li>Expand and enhance reporting capabilities through the incorporation of leading indicators, including authorization and admission/discharge/transfer (ADT) data.</li> </ul> <p><strong>Strategic Analysis &amp; Problem Resolution</strong></p> <ul> <li>Investigate emerging trends, operational issues, and root causes affecting healthcare cost, utilization, and performance.</li> <li>Develop recommendations and implementation strategies that address identified challenges.</li> <li>Lead multiple projects simultaneously while ensuring timely and accurate delivery of analytical work products.</li> <li>Serve as an analytical consultant and subject matter expert to business partners across the organization.</li> </ul> <p><strong>Innovation &amp; Continuous Improvement</strong></p> <ul> <li>Leverage AI, automation, and advanced analytics tools to improve reporting accuracy, efficiency, and scalability.</li> <li>Identify opportunities to streamline analytical processes and improve data quality.</li> <li>Monitor healthcare utilization trends to assess the impact of utilization management programs, benefit changes, and policy decisions.</li> <li>Support the development of new analytical products, dashboards, and business insights.</li> </ul>
Requirements: <p><strong>Education</strong></p> <p>Bachelor&rsquo;s degree in healthcare informatics, Health Information Management, Health Analytics, Data Science, Statistics, Information Systems, Computer Science, Public Health, Healthcare Administration, Economics, Business Analytics, or a related field is required.</p> <p>Master's Degree in a related discipline is preferred.</p> <p><strong>Experience</strong></p> <ul> <li>Six (6) or more years of experience in healthcare analytics, healthcare economics, utilization management, provider performance, value-based care, financial analysis, business intelligence, or related analytical disciplines.</li> <li>Experience working with healthcare claims, authorization, provider, utilization, and membership data preferred.</li> <li>Experience supporting vendor performance programs, healthcare operations, or value-based contracting preferred.</li> </ul> <p><strong>Technical Skills</strong></p> <ul> <li>Advanced SQL skills required.</li> <li>Experience with Databricks, Tableau, SAS, Python, Power BI, or similar analytical and reporting tools preferred.</li> <li>Strong understanding of healthcare data structures, claims processing, utilization management, and performance measurement methodologies.</li> <li>Ability to analyze large datasets and translate findings into actionable business recommendations.</li> </ul> <p><strong>Professional Skills</strong></p> <ul> <li>Excellent analytical, problem-solving, and critical-thinking abilities.</li> <li>Strong verbal and written communication skills with the ability to communicate complex concepts to both technical and non-technical audiences.</li> <li>Demonstrated ability to develop executive-ready presentations, reports, and dashboards.</li> <li>Ability to manage multiple priorities and projects simultaneously.</li> <li>Proven ability to work independently and collaborate effectively across all levels of the organization.</li> </ul>