Job Description
About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Impact You Will Have Blue Cross and Blue Shield of Minnesota is hiring a Senior Submissions Healthcare Data Analyst in Eagan, MN. In this role, you will support the Submissions Team by performing data analysis, quality assurance, and regulatory submissions with a focus on Risk Adjustment and Medicare Advantage (MA) data. You'll collaborate with business analysts, actuaries and other cross-functional teams to deliver accurate reports, resolve risk adjustment challenges and provide data-driven solutions.
This position requires expertise in healthcare data-including claims, membership, and provider information-along with hands-on experience in risk adjustment models, HCC analysis, RAF score calculations, and file sets such as 837 claim files, MAO-002 response files, and MAO-004 response files. You will also develop Power BI dashboards and leverage expert-level SQL skills to ensure compliance and actionable insights.
Candidates must have strong healthcare data analytics experience, regulatory reporting knowledge, and familiarity with risk adjustment methodologies, combined with hands-on skills in SQL and Power BI. Encounter Data submissions experience focused on ACA, Medicaid, and/or Medicare Advantage is essential. Knowledge of CMS ACA EDGE, Medicare Advantage response files (MAOs), and/or Minnesota Medicaid rejection reports is highly valued. Proficiency with healthcare file formats, understanding of CMS guidelines, and excellent problem-solving abilities are important. Strong communication and collaboration skills are vital for guiding teams and supporting organizational goals in a fast-paced, regulated environment.
Your Responsibilities - Uses databases for analysis and dissemination of information.
- Performs complex analysis of data.
- Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.
- Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.
- Implements improvements to process, analysis, and research methods.
- Works with principal positions and management to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.
- Assists in the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.
- May represent the division on corporate projects and may have leadership roles on these teams.
- Independently manages issues that may arise on multiple tasks or projects with limited management involvement.
- Acts as a resource for other members of the department and company on business issues and may be responsible for training and guidance of other employees.
Required Skills and Experience - 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- 2 years experience using programming and statistical software (SQL), use of various databases and other data sources, and performing analytics.
- Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
- Ability to perform and interpret a variety of statistical analyses.
- Demonstrated ability to evaluate and interpret complex data.
- Demonstrated ability to handle multiple tasks with competing priorities.
- Demonstrated problem solving skills.
- Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to individuals and groups with varying levels of analytics expertise in a clear and concise manner.
- Demonstrated ability to present complex results and conclusions to non-technical audiences and to senior decision-makers.
- Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical, and/or clinical.
- High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills and Experience - Encounter Data submissions experience with a focus on ACA, Medicaid and / or Medicare Advantage strongly preferred.
- Knowledge of CMS ACA EDGE, Medicare Advantage response files (MAOs) and/or Minnesota Medicaid rejection reports.
- Experience with managed care and health care claims
- Experience creating and maintaining reporting in Power BI.
- High level expertise with SQL.
- Familiarity with clinical coding (ICD-10-CM) and revenue cycles.
- Knowledge of managed care and health care claims preferred.
Role Designation Teleworker
Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Compensation and Benefits $90,800.00 - $120,300.00 - $149,800.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
- Medical, dental, and vision insurance
- Life insurance
- 401k
- Paid Time Off (PTO)
- Volunteer Paid Time Off (VPTO)
- And more
To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Job Tags
Full time, For contractors, Remote work