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Job Summary:
Manages a team through providing oversight, strategy implementation and execution for Medicare Risk Adjustment Programs. This role plays a pivotal role in managing and optimizing Medicare Advantage (MA) risk adjustment programs. This position will lead the design, planning, measurement, predictive analytic modeling and facilitate an evidenced based approach to drive decisions that enable the growth objectives of the business by leveraging data to enhance revenue accuracy, improve provider documentation, and ensure regulatory compliance Essential Functions:
- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Oversee the end-to-end strategy for risk adjustment programs, including prospective and retrospective processes. This involves managing provider workflows, chart reviews, and coding validation to ensure accurate documentation under CMS-HCC models.
- Partner with actuarial and finance teams to support bid development, producing defensible risk score projections, trend analysis, and revenue assumptions. This includes communicating results to executive leadership.
- Manage work to produce customer value by planning and forecasting, setting objectives and priorities, establishing goals, clarifying accountabilities, assigning work and utilizing management and financial controls.
- Lead analysis, provide recommendations, and represent Analytics
- Work closely with leaders across business areas to drive results across the business
- Manage levels of performance and assist with employees' professional growth by planning and building an effective organization; communicating effectively; coordinating with others; maintaining employee morale; motivating, recognizing and rewarding others; coaching and developing others, and engaging in self-development.
- Manage business and public relationships and situations to obtain better business outcomes; communicate effectively and coordinate with others.
- Develop, prioritize and implement strategy; set policies and procedures and manage creativity and innovation with primary goal of impacting health business
Required Work Experience:
8+ years related work experience. Experience Details: Strong Risk Adjustment experience in commercial and or Medicare.
3+ years direct supervisory/management experience
Related Bachelor's degree or additional related equivalent work experience
Experience working with statistical methodologies and risk adjustment
Experience writing SQL /SAS or related code to perform quantitative risk score analysis
Advanced Excel skills Experience using algorithms and inferential statistics. Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills
In-depth business process knowledge of several key business functional areas
Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences
Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
Experience communicating and presenting detailed business and financial information
Ability to understand overall Analytics strategy and apply/implement the strategy in assigned projects/initiatives/programs Preferred Qualifications: Experience working within the healthcare insurance industry
Bachelor's degree in a related field Business Analytics, Health Economics or similar program
Master's degree in a related field General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer:
As a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan including employer match;
- Paid time off, volunteer time off, 10 holidays and 2 well-being days;
- Additional voluntary benefits available; and
- A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $119,400 - $194,000
Typical Annualized Hiring Range: $119,400 - $149,200
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
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Florida Blue
life insurance, paid time off
Jun 03, 2026