Manager, Risk Adjustment Operations
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Job Description
Risk Adjustment Operations Manager leading analytics, reporting, and process alignment for Horizon Blue Cross Blue Shield of New Jersey. Managing staff and enterprise initiatives across health plan operations.
Responsibilities:
- 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
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