Manager, Risk Adjustment Operations

Job not on LinkedIn

🔥 2 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $97.8k - $133.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Lead coordination of analytics and process functions within the Enterprise Risk Adjustment department • Gather and organize status of operational activities across the risk adjustment department • Participate in or lead internal or external project workgroups and presentations • Provide regular reporting on operations and analytics functions, with actionable insights for department and enterprise leadership • Author presentation materials and conduct research for external and leadership audiences • Request analytics and reporting to support risk adjustment alignment decisions • Collaborate with business unit and divisional leaders to define problems, design solutions, and manage implementation related to product development, network design, and pricing practices • Present risk adjustment materials and status updates to Horizon leadership • Escalate departmental issues and track them to resolution • Support management through ad hoc reporting and special projects • Manage, develop, and train staff; develop and monitor goals; conduct annual performance reviews; administer staff salaries

🎯 Requirements

• Bachelor degree preferred or relevant experience in lieu of degree • Minimum of six (6) years’ experience • At least four (4) years’ experience in a project support or analysis role • Requires people management experience • Detailed knowledge of risk adjustment and health plan operations • Knowledge of project management methodologies • Knowledge of the creation and management of insurance products, network contracting and design, healthcare management programs, actuarial pricing practices, and analytics functions and techniques • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement