Manager, Risk Adjustment Operations

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $83.8k - $157.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives • Develop and maintain integrated project plans, operational calendars, risk logs, and status reporting • Monitor program performance through dashboards, KPIs, and operational metrics • Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, and others • Hold internal teams and external vendors accountable for operational performance • Proactively identify operational barriers and develop mitigation plans • Lead operational vendor onboarding and offboarding activities

🎯 Requirements

• 5 years of Operations and/or Program management • 3 years of Risk Adjustment Operations or Program Management • Experience leading complex, cross-functional operational initiatives • Experience supporting vendor selection and evaluations • Strong analytical and problem-solving skills • Proficiency with Microsoft Office applications, including advanced Excel skills • Bachelor’s degree in business administration, Healthcare Administration, Public Health, Health Information Management, Finance, Economics or 9 years relevant and progressive experience in lieu of bachelor's degree • Lean Six Sigma or other operational excellence/process improvement certification preferred

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off, Holidays, and Volunteer time off • Incentive Plan • Tuition Reimbursement