Manager, Risk Adjustment Operations

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Oversee the coordination of analytics and process operations within the Enterprise Risk Adjustment department.

• Collect and organize updates on operational activities throughout the risk adjustment department.

• Engage in or lead internal or external project workgroups and presentations.

• Deliver regular reports on operations and analytics functions, providing actionable insights for department and enterprise leadership.

• Create presentation materials and conduct research for both external and leadership audiences.

• Request analytics and reporting to facilitate risk adjustment alignment decisions.

• Collaborate with business unit and divisional leaders to identify issues, design solutions, and oversee implementation related to product development, network design, and pricing strategies.

• Present risk adjustment materials and status updates to Horizon leadership.

• Elevate departmental issues and ensure they are tracked to resolution.

• Assist management through ad hoc reporting and special projects.

• Manage, develop, and train staff; set and monitor goals; conduct annual performance evaluations; administer staff compensation.

⛳️ Requirements

• A Bachelor’s degree is preferred or relevant experience may be considered in place of a degree.

• A minimum of six (6) years of professional experience is required.

• At least four (4) years of experience in a project support or analytical role is necessary.

• Experience in people management is required.

• In-depth knowledge of risk adjustment and operations within health plans is essential.

• Familiarity with project management methodologies is required.

• Understanding of the development and management of insurance products, network contracting and design, healthcare management programs, actuarial pricing practices, as well as analytics functions and techniques is necessary.

• Employees must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision.

• Retirement plans available.

• Generous paid time off (PTO).

• Incentive plans offered.

• Wellness programs to support employee health.

• Paid Volunteer Time Off.

• Tuition reimbursement for further education.