RADV Business Analyst

About the Role

We are looking for a business process analyst to support Risk Adjustment Data Validation activities within a highly regulated health insurance environment. This long-term contract position focuses on strengthening audit operations through careful review of member, enrollment, and claims-related information while helping maintain compliance and reporting accuracy. Based in Minnesota, but able to work fully remote, this opportunity is well suited for a detail-focused analyst who can manage complex data issues, coordinate with cross-functional partners, and contribute to successful audit execution in a remote work setting.

Responsibilities

• Manage and refine Excel-based trackers, audit logs, and supporting documentation to keep project records accurate and current.
• Examine demographic, eligibility, and enrollment information to identify errors, confirm completeness, and support audit preparedness.
• Assess medical, pharmacy, and claims records to verify that submitted data aligns with required standards and supporting evidence.
• Analyze reporting results to detect omitted or conflicting diagnosis details that may affect Hierarchical Condition Category outcomes.
• Investigate data inconsistencies across multiple sources, resolve issues when possible, and elevate critical risks or obstacles to leadership in a timely manner.
• Prepare recurring project updates that summarize progress, open issues, and milestone status for stakeholders.
• Partner with internal teams and external vendors to coordinate deliverables and maintain momentum against audit timelines.
• Apply current CMS guidance, audit protocols, and privacy requirements when handling sensitive healthcare information.
• Participate in project and cross-functional meetings, adjust to shifting priorities, and provide support for related operational initiatives as needed.

Requirements

• At least 5 years of experience in the healthcare industry working with claims, membership, provider, or eligibility data.
• Minimum 5 years of business analysis or operational analysis experience in a structured, deadline-driven environment.
• Advanced ability to use Microsoft Excel for tracking, validation, reconciliation, and reporting activities.
• Strong understanding of audit support, compliance expectations, and data quality review within healthcare operations.
• Demonstrated skill in researching discrepancies, interpreting findings, and communicating resolutions clearly to stakeholders.
• Ability to work independently in a remote setting while collaborating effectively across multiple teams and time zones.
• Strong written and verbal communication skills, sound judgment, and the ability to manage multiple priorities with close attention to detail.

About Robert Half

Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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