Monterey Park, CA

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The Clinical Quality Analytics and Informatics supports corporate and departmental strategies and goals for the annual HEDIS submission process. The Data Analyst - Heath Experienced will report to the manager of HEDIS measurement. In this role you will you will collect data from various internal systems (example Claims processing or membership systems) and external systems (EMR/EHR) and converts those data to actionable insights to guide business decision making for BSC populations' health management and quality of care.

Your Work

In this role, you will:

• Develop and conduct evaluations and studies within limited time frames and produce analyses that are easy for non-technical persons to understand
• Develop technical specs and execute a work plan for uncomplicated analyses
• Prepare documents, correspondence and other communication materials to convey information to appropriate audiences internally and/or externally
• Participate in the process to design and implement reports/analytics; able to follow business requirement and technical specification to bring the product to fruition
• Assist in identifying systems and operational problems and recommend solutions and changes to streamline procedures for more effective reporting
• Develops, implements, and documents quality assurance (QA) processes to ensure that reported data is accurate and reliable.
• Recommends and implements solutions for identified problems/root cause pertaining to clinical data used for HEDIS reporting.
• Provide analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, or, external

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 3 years of prior relevant experience
• Requires at least 1 year of experience in Health Care (managed care, academic, or gov't payer) and demonstrated ability to work with all clinical coding systems (e.g., ICD10, CPT, DRG, LOINC, RxHUB)
• Experience in SAS Programing skills or equivalent

Our Values

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short
• Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals