Expert Analyst

Philadelphia, Pennsylvania


The Risk adjustment Data and Analytics Expert Analyst is responsible for comprehensive data mining, data management and manipulation techniques to report on Medicare Advantage (MA) and offering assistance in organizing and facilitating strategic program creation and execution, with minimal direction from Principal BI Analyst, Supervisor, or leadership. This role assists in researching and compiling appropriate and relevant data and feedback for risk adjustment activities.


  • Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
  • Generating various reports using Claims, Membership, MMR, RAPS, MAO files.
  • Create data insights from cloud using Data science technics by using Python or SQL
  • Possesses and maintains comprehensive knowledge of MA or ACA business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
  • Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters with minimal guidance from senior team members or leadership.
  • Designs, develops, tests, and delivers solutions comprising of components, reports, and data stores per requested deliverable directions with minimal guidance from senior team members or leadership.
  • Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
  • Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
  • Assists in identifying resolution of challenges and issues in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
  • Assists in development of plans, reports, papers, and/or other material creation.
  • Provides assistance and feedback to corporate staff as required.
  • Assists with and documents feedback between corporate business areas and participates in group or committee discussions.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.



Bachelor's degree in Business Administration, Economics, Health Care, Data Analytics, Data Science, Information Systems, Statistics, or a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.


Four (4) - Six (6) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role. Senior Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities.

  • Strong Experience on Medicare Risk Adjustment process
  • Strong experience using Data science technics to create data stories to provide data insights to leadership.
  • Strong knowledge on data mining is required.
  • Strong execution in a fast-paced environment with tight deadlines.
  • Administer and adhere to corporate and departmental policies, practices and procedures.
  • Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.
  • Strong ability to learn new technology, techniques, and processes.
  • Strong knowledge and use of existing software packages (Power BI, Access, PowerPoint, Excel, Word, etc.).
  • Strong knowledge of data languages such as SQL, T-Sql, Python, SAS, etc.
  • Strong knowledge of various operating systems such as Windows, LINUX, etc.; Knowledge of files/databases on the operating systems.
  • Strong knowledge of various platforms such as Cloud PaaS, SaaS.
  • Strong analytical, organizational, planning, and problem-solving skills.
  • Affirmation from leadership based upon delivered MA or ACA solutions.
  • Strong understanding of and ability to apply statistical inference.
  • Strong ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Strong ability to write reports and correspondence. Strong ability to speak effectively before groups of customers or employees of organization.
  • Strong ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Strong ability to compute rate, ratio, and percent, and to draw and interpret bar graphs.
  • Strong ability to define problems, collect data, establish facts, and draw valid conclusions. Strong ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  • Strong ability to develop project management, meeting process, and presentation skills.
  • Strong ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.
  • Other related skills and/or abilities may be required to perform this job.


Work is performed in an office setting with no unusual hazards.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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