Job DescriptionYour Role The HCQA team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield's network of physicians, hospitals, ambulatory surgery centers, HMO IPA's, and medical groups. Our team (Network Performance Analysis and Contracts) is part of the HCQA Division and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield's network of physicians, hospitals, ambulatory surgery centers, HMO IPA's, and medical groups. In this role you will (1) provide analysis and consultative services on new network design in support of corporate strategic roadmap; (2) manages and oversees development and production of regulatory network filing artifacts as required by regulators for all Blue Shield and Promise Health Plan Commercial, Medi-Cal and Medicare networks; (3) provides network analytics, reporting and oversight on existing networks to ensure meeting regulatory access, availability standards as defined by regulators; and (4) provides consultative and analytical support as needed to during contract negotiations, pricing activities and product/network strategy roadmap planning. The Data Analytics Consultant will report to the Manager. This role serves as a critical analytical and strategic partner to the organization, connecting network performance data with regulatory requirements and business priorities. Your ability to identify access trends, communicate meaningful insights, and collaborate across teams will help drive regulatory readiness, strengthen network performance, and support sustainable solutions for member access.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
ResponsibilitiesYour Work In this role, you will:
- Lead network adequacy and Access & Availability analytics, monitoring provider access, capacity, availability, and compliance across Commercial, Medicare, and Medi-Cal networks.
- Interpret and incorporate state and federal regulatory requirements into network policies, procedures, analytical methodologies, and compliance assessment.
- Conduct complex network analyses, including geographic access, provider-to-member ratios, panel status, and access gaps, to inform network strategy, remediation, and expansion efforts.
- Prepare, validate, and oversee data used for regulatory reporting and filings, supporting compliance with DMHC, CMS, DHCS, CDI, and NCQA requirements.
- Develop dashboards, reports, and executive-level insights that translate complex data into actionable information on network performance, access trends, compliance risks, and regulatory readiness.
- Collaborate with internal and external stakeholders to assess regulatory changes, identify compliance and network risks, and implement data-driven solutions that strengthen network performance and member access.
- Present complex analytical findings and trends clearly and effectively to internal and external audiences using Excel pivots tables, PowerPoint presentations, report grids, tables and other data visualizations.
- Leverage advanced analytics tools (SQL, SAS, Power BI, Tableau, Excel) to identify trends, anomalies, and opportunities for operational improvement.
- Perform data validation, reconciliation, and quality assurance activities to ensure accuracy and audit readiness of regulatory submissions and executive reporting.
- Develop and identify trends, and scenario-based analyses to assess network performance, regulatory impacts, and emerging access risks.
- Translate complex technical findings into clear business insights and recommendations for committee, executive leadership and non-technical stakeholders.
QualificationsYour Knowledge and Experience - Bachelor's degree or High School Diploma/GED and 4 years of relevant experience in lieu of a degree
- Requires at least 7 years' experience in Health Care (managed care, academic, or gov't payer)
- Preferred MPH, MBA, MS, MA
- Ability to develop new SAS programs and SQL scripts that improve the efficiency of the work of others
- Broad knowledge of project management
- Experience with MS Office, especially Excel and Access, Unix, SQL/PL-SQL,SAS
- Familiarity with visualization tools such as Tableau
- Strong analytics skills, strong problem-solving skills. Strong Presentation skills.
- Must possess excellent time management and organizational skills to be able to handle multiple complex projects simultaneously
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
About the TeamAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
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 listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
- For most teams, this means coming into the office two days per week.
- Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
