Job Description

This role is responsible for providing advanced analytical and modeling expertise supporting value-based care performance measurement and population risk normalization. The Sr. Population Risk Performance Analyst applies population risk models to attributed member populations to ensure accurate, consistent, and defensible financial and quality performance measurement across value-based care programs.

The role operationalizes risk and actuarial modeling methodologies to support total cost of care evaluation, performance reconciliation, forecasting, and provider settlement processes. This position partners closely with actuarial, finance, clinical economics, and value-based care operations teams to ensure performance outcomes appropriately reflect population acuity and contractual measurement intent.

This role is distinct from coding-based risk adjustment functions and focuses on performance measurement methodology and financial normalization.

What You Will Do

• Apply population risk and actuarial models to normalize performance measurement across value-based care programs.
• Operationalize CMS-HCC, Milliman, and comparable population risk methodologies for performance evaluation and financial measurement.
• Support development and maintenance of risk-normalized total cost of care and quality performance metrics.
• Validate performance measurement methodologies used in shared savings, downside risk, and alternative payment models.
• Analyze population risk movement and evaluate impacts on program financial performance and provider outcomes.
• Partner with actuarial and finance teams to align modeling assumptions with contractual measurement logic.

• Identify and investigate performance variances driven by population acuity, attribution changes, coding variation, or data completeness.

• Support performance year reconciliation, settlement calculations, and financial exposure analysis.
• Define and document measurement methodologies, assumptions, and model governance controls.
• Collaborate with analytics and data engineering teams to integrate risk modeling logic into reporting and measurement pipelines.
• Provide analytical expertise supporting provider performance reviews and measurement inquiries.
• Translate complex modeling outcomes into clear insights for operational and executive stakeholders.
• Ensure consistency and repeatability of population measurement processes across programs and performance periods.
• Serve as subject matter expert for population risk interpretation supporting value-based care strategy and operations.

What You Bring

• Bachelor's degree or advanced degree in healthcare administration, business, public health, or related field.

• 5+ years of experience in related field.

• In lieu of degree, 7+ years of experience in related field

• Demonstrated experience working with population risk models including CMS-HCC and Milliman methodologies (or equivalent).
• Experience analyzing healthcare claims and eligibility datasets.
• Strong SQL and analytical data experience.

Preferred Qualifications

• Experience supporting Medicare Advantage and Commercial value-based care programs.

• Familiarity with total cost of care measurement and shared savings models.

• Experience collaborating with actuarial, finance, or clinical economics teams.

• Knowledge of attribution methodologies and population performance analytics.

• Experience supporting provider settlement or reconciliation processes.

#LI-Hybrid

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$98,092.00 - $156,947.00

Skills

Analytical Analysis, Data Analysis, Data Analysis Reporting, Data Analytics, Data Engineering, Data Governance, Data Mining, Data Science, Identifying Trends, Trend Analysis

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com