Job Description
Insight Global is seeking a highly experienced Principal Risk Adjustment Analyst (SME) to serve as a strategic leader within the Risk Adjustment organization. This individual will partner with Risk Adjustment Operations, Clinical Programs, Finance, Actuarial, Quality, Provider Network Management, and Data Engineering teams to optimize risk score performance, improve coding accuracy, and support enterprise-wide Medicare Advantage and value-based care initiatives.
The Principal Analyst will act as the subject matter expert for CMS Risk Adjustment methodologies, HCC coding, RAF forecasting, provider performance analytics, and regulatory compliance. This role will leverage advanced analytics and healthcare data expertise to identify opportunities, develop actionable insights, and drive measurable improvements in risk adjustment accuracy and financial performance.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
-8+ years of healthcare payer analytics experience, with at least 5 years focused specifically on Risk Adjustment.
-Deep expertise in CMS-HCC, Medicare Advantage, RAF scoring, and Risk Adjustment methodologies.
-Advanced proficiency with SQL and large healthcare datasets including claims, encounters, membership, and provider data.
-Previous Snowflake experience for querying and building data sets
-Experience building executive-level dashboards and analytics solutions using Snowflake, Power BI, Tableau, or similar BI tools.
-Strong understanding of healthcare payer operations including Medicare, Medicaid, commercial insurance, and value-based care programs.
-Demonstrated ability to influence senior leaders and translate analytical insights into strategic business decisions.
Nice to Have Skills & Experience
Snowflake certifications
Facets experience
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.