Risk Adjustment Consulting, Experienced

Your Role

The Risk Adjustment Retrospective Analytics team focuses on delivering complete and accurate analytics for Prospective and Retrospective suspecting, financial impact calculations, and data submission. The Risk Adjustment Analyst, Experienced will report to the Manager of Risk Adjustment Analytics. In this role you will develop and refine Risk Adjustment Suspecting logic, quantify the financial impact of the Risk Adjustment programs, and support complete and accurate data submission for both Medicare Advantage and ACA Chart Review Programs.

• Requires a bachelor's degree in mathematics, statistics, computer science or related field or equivalent business experience
• Requires at least 3 years of professional experience in healthcare preferably in risk adjustment or actuarial
• Requires practical knowledge of job area obtained through professional experience and advanced education
• Requires proficiency with MS Office, including Excel, Word, Power Point
• Familiarity with SQL, SAS, R, Python or other data analysis tools strongly preferred
• Prior exposure to claims data, membership data, premium data, and risk score assignment processes strongly preferred
• Excellent communication and presentation skills with the ability to translate complex information to cross‑functional teams (e.g., vendor management, product, finance, compliance)