Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a health solutions organization focused on improving healthcare quality, affordability, and member experience. The Risk Adjustment Operations Manager will coordinate analytics and process functions, provide reporting and business insights, lead alignment initiatives across business units, and manage staff within the Enterprise Risk Adjustment department.
Responsibilities
- Gather and organize status of operational activities across the risk adjustment department
- Participate in or lead internal or external project workgroup(s) and presentations
- Provider regular reporting on the status of operations and analytics functions and provide actionable insight to department and enterprise leadership
- Author presentation materials including necessary research for external and leadership audiences for department leadership
- Request analytics and reporting to support decision making related to alignment of Horizon business units to risk adjustment
- Meet with business unit and divisional leaders across Horizon to define the problem or opportunity, collaborate on solution design, and manage the implementation of alignment solutions related to product development, network design, and pricing practices
- Present various risk adjustment materials or status to Horizon leadership
- Escalate issues or other departmental problems 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, and administers salaries for the staff
Skills
- Relevant experience in lieu of degree
- Minimum of six (6) years' experience with 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
- Bachelor degree preferred
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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