Job Summary
JOB DESCRIPTION
Medicare Risk Adjustment is the department that is accountable for revenue generating through data-driven research, measurement, and strategic and operational insights into the lifetime value of Florida Blue's relationships with members and providers.
The Specialist III -- Risk Adjustment has awareness of (i) HHS, CMS, and other risk adjustment models; (ii) the enterprise data required for calculations of MA and Commercial risk scores; and (iii) the tools (primarily SAS) used to extract the data and perform internal research and measurements on the value streams on Florida Blue's Government and Commercial business. As an individual contributor and at the direction of his/her manager, his/her activities are focused on completing projects involving (a) the measurement of risk adjustment models' and behavioral impact on the Company's revenue (including the construction of dynamic models); and (b) providing other support to operational areas that are tasked with carrying out the tactics needed to implement cost-effective revenue management programs. To the extent experienced and capable, she/he may also assist the Specialist IV - Risk Adjustment, Specialist V - Risk Adjustment, and Consultant - Risk Adjustment in the research of value streams, and/or the identification of strategies in response to the work outline above.
What You Will Be Doing
- Under the direction of the Sr. Manager or Consultant - Risk Adjustment, and in collaboration with others on the team; perform value-stream research, measurement, and model-building; develop strategies for, and calculation in support of Risk Adjustment operations; and review the work of peers.
- Research, validate, and analyze data for monitoring and reporting, strategic & tactical support, and research & development projects.
- Draft reports and exhibits for review by manager or project leaders
- Provide support to operational areas in implementing cost effective revenue programs.
- Recommend new ways of performing work task or projects, applying research and/or additional benchmarks to generate solutions.
- The essential functions listed represent the major duties of this role, additional duties may be assigned.
What You Must Have
2+ years related work experience. Experience Details: risk adjustment
Related Bachelor’s degree or additional related equivalent work experience
Additional Required Qualifications
Statistics, management, actuarial science, computer science, data science, risk management, insurance, health care finance, public health, or related field, and 2 years of work experience in risk adjustment, cost-benefit analysis, elimination, reduction, trend analysis, algorithm development, deduction, inference, recursion, or model-building OR Master's or doctorate degree in statistics, management, actuarial science, computer science, data science, risk management, insurance, health care finance, public health, or related field Intermediate proficiency in Excel Beginner-level proficiency in SAS
What We Would Prefer You Have
- SAS certification(s) or SQL
- Knowledge State or Federal risk adjustment models
- Knowledge of Medicare Advantage, Medicare Part D, Medicaid, or Qualified Health Plans
- Data mining knowledge
- Predictive modeling knowledge
- Knowledge of the Affordable Care Act (ACA) Knowledge of other risk adjustment models
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, Short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan includes employer contribution and employer match;
- Paid time off, volunteer time off, and 11 holidays
- Additional voluntary benefits available; and
- A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Typical Annualized Hiring Range: $62,500 - $78,100
Annualized Salary Range: $62,500 - $101,500
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
About Us
At GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from.
From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone’s contribution has the power to help people and communities achieve better health. Find your new team today.
About The Team
Florida Blue, A GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communicating to achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the members first.
