Job Description

Your Role

The Blue Shield of California Growth and Servicing analytics organization is part of the centralized Data and Analytics organization and oversees Channel Analytics including Digital, Marketing, Claims, Appeals, Grievances, Disputes and Line of Business. The Medical Informatics Analyst – Consultant (Medical Specialty Integration) will report to the Senior Manager of Medical Informatics and play a critical role in advancing the health plan’s specialty lines of business (dental, vision, and life insurance). This role is strategically designed to focus 70% on analytics and 30% on reporting, emphasizing the use of machine learning models and predictive analytics to drive member acquisition, retention, engagement, and growth, as well as identifying opportunities for cross-selling.

The successful candidate will have a robust understanding of both medical and specialty benefits, a proven ability to leverage existing analytics solutions across benefit types, and a demonstrated capacity to improve operational efficiency through data integration and actionable insights. Passionate about improving member health outcomes through data and analytics, the candidate will actively engage with stakeholders to frame business problems, recommend analytic frameworks, and deliver impactful, high-quality solutions.

A product-oriented mindset and the ability to influence outcomes in a matrixed environment are essential to excel in this role.

Your Work

In this role you will:

• Integrate specialty data (dental and vision) with medical benefits data, creating comprehensive employer reports that identify cross-selling opportunities and improve member experiences.
• Lead the development and deployment of machine learning models to predict and enhance member acquisition, retention, engagement, and growth within the dental and vision lines of business.
• Perform predictive and prescriptive analytics to understand member behavior, identify intervention opportunities, and recommend strategies for growth and retention.
• Collaborate with Specialty Line of Business (LOB) teams to align business goals with analytics solutions and deliver data-driven recommendations.
• Support regulatory reporting and monthly employer reporting by working closely with the data services team to develop integrated data models spanning medical, dental, and vision benefits.
• Partner with data engineering teams to ensure seamless integration of claims data from multiple sources into the analytics environment.
• Analyze structured and unstructured data to uncover pain points, establish causality, and recommend prioritized solutions based on insights.
• Build intuitive reports and dashboards to empower stakeholders with data-driven decision-making tools.
• Monitor and evaluate the effectiveness of marketing campaigns, engagement strategies, and product performance using actionable insights.
• Assist in defining strategic business rules and KPIs for reporting and analytics within the specialty benefits domain.
• Be enthusiastic about solving complex challenges, improving member satisfaction, and driving health outcomes.
• Thrive in a matrixed environment, balancing priorities across teams and stakeholders.
• Approach problems with curiosity, creativity, and a solutions-driven mindset.
• Passionate about improving member outcomes while delivering value to the organization.

Your Knowledge and Experience

• Bachelor’s degree in data science, health informatics, statistics, mathematics, economics, engineering or related quantitative fields. Master’s degree preferred
• Minimum 7 years of prior relevant experience, and 5 years’ experience in Health Care (managed care, academic, or gov't payer)
• 5+ years working with Claims and Membership, or similar data strongly preferred.
• Strongly preferred working knowledge of Snowflake, Databricks, RDBMS (Oracle, Netezza etc.)
• Advanced Python, SQL SAS or equivalent skills to interact with data
• Strong experience with machine learning techniques such as classification, clustering, and predictive modeling, especially in member engagement and retention contexts
• Experience with dental, vision, and medical claims data integration and analysis.
• Proven ability to integrate and analyze dental, vision, and medical claims data, providing actionable insights for employer groups and internal stakeholders.
• Familiarity with cross-selling strategies and member engagement techniques in the healthcare space
• Hands-on Experience with data visualization tools (e.g., Tableau, Power BI) to present insights in a clear and actionable manner.
• Excellent communication skills to effectively collaborate with the Specialty LOB team and align analytics initiatives with business strategy
• Demonstrated ability to partner across all levels of staff and adapt quickly to shifting priorities.

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