Director of Value Performance Submissions and Analytics

Job Duties

Develop, lead, and provide strategic direction for a high performing team responsible for maintaining, executing, and evaluating initiative impacts using the risk adjustment and quality analytics models across ACA Commercial, Medicare, and Medicaid. Develop, lead, and provide strategic direction for a high performing team responsible for the execution and day-to-day management of data submissions for ACA Commercial, Medicare, and Medicaid risk adjustment and quality programs. Design and execute complex analytic strategies - including benchmarking, prevalence tracking, cohort stratification, predictive modeling, and suspecting logic leading to accurate risk adjustment scores and supporting quality measure gap closure. Direct data preparation for analytic efforts by establishing data quality and accuracy standards; approving system improvements to enhance overall quality of data; championing the resolution of critical issues as appropriate; and reviewing complex or high-profile data sets. Oversee the development, implementation, and automation of business and reporting strategies by partnering with key stakeholders to ensure their design, planning, and implementation needs are being met while ensuring alignment with strategic business objectives; reviewing and approving results and roadmaps as appropriate; ensuring compliance with standards and guidelines for data reports, visualizations, and / or interactive Business Intelligence (BI) reports; and sharing insights with stakeholders on key findings. Direct research, analyses, and interpretation of risk adjustment and quality data and provide technical assistance to other departments including Underwriting, Government Programs, Finance, Network Management, Health Management, Sales and Marketing, Legal, and Senior Staff. Responsible for synthesizing complex findings into clear, compelling narratives that support strategic decision-making and stakeholder alignment. Review and maintain processes to assess and prevent data loss that may impact risk adjustment accuracy or quality programs. Engage, participate, and present in risk adjustment and quality strategic planning activities by partnering with internal stakeholders to develop strategies, goals, objectives and initiatives that align to corporate and divisional priorities. Provides leadership and oversight with responsibility for key employment decisions including selection, onboarding, performance management, coaching skill and career development, policy administration, employee relations, and cost control.

Minimum Education Required Skills and Experience

Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment. 7+ years of related professional experience, with 3+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered. Excellent knowledge of Medicare Advantage and / or the ACA marketplace and understanding of CMS initiatives and reasoning. Advanced knowledge of Microsoft SQL Server and its BI tools (SSIS, SSRS), with strong data capabilities to interpret complex data and develop strategic data-driven recommendations Strong knowledge of data visualization software. Exceptional creative thinking, problem-solving, and critical thinking skills. Excellent communication, collaboration, consultation, presentation, and interpersonal skills. Clearly and effectively communicates technical concepts, issues, and solutions to non-technical audiences. Ability to lead others and build relationships. Demonstrated delegation and management skills. High school diploma (or equivalency) and legal authorization to work in the U.S.

Minimum Experience Required Preferred Skills and Experience

Master's degree in Finance, Mathematics, Computer Science, Health Science or Data Science. Experience leading Risk Adjustment submission teams in a Health insurance companies, Healthcare providers, Healthcare technology add regulators (CMS, department of health, etc) and consulting companies. Experience leading HEDIS data collection and submissions. Knowledge of statistical software (R or SAS).

Compensation and Benefits

Pay Range : $132,300.00 - $224,900.00 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(https : / / tbcdn.talentbrew.com / company / 42354 / gst_v1_0 / pdf / BCBSMN_Benefits_2025.pdf).

Role Designation

Hybrid Anchored in Connection Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Equal Employment Opportunity Statement

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.