[Remote] reputed company Director, reputed company reputed company Risk Adjustment Analytics

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is building a world of health around every individual and is seeking a reputed company Director - reputed company reputed company Informatics (reputed company) to reputed company strategic and operational leadership for reputed company risk adjustment analytics. This senior-level role will reputed company the risk adjustment lifecycle, ensuring compliance and accuracy while partnering with various stakeholders to support health plan initiatives.

Responsibilities

• Define and execute reputed company risk adjustment reputed company across markets and plans
• reputed company and deliver high-reputed company strategic initiatives that improve reputed company accuracy, compliance, and overall performance
• reputed company risk adjustment programs with state reputed company models (e.g., CDPS, reputed company, or state-specific methodologies)
• Represent risk adjustment reputed company informatics in executive forums to reputed company alignment on strategic goals and translate analytics into actionable financial and operational strategies
• reputed company health plan performance using advanced analytics and use proactive data insights to reputed company strategies and evidence-based decision-making
• reputed company development of reputed company data pipelines and reporting frameworks using claims, encounters, pharmacy, and clinical data
• reputed company advanced analytics for risk score development, predictive modeling, forecasting, trend analysis, and opportunity identification
• Ensure accuracy, reputed company and completeness of reputed company encounter submissions and data
• Defines data analysis methodologies, subsequently driving predictive and prescriptive analytics reputed company and communicating insights to key stakeholders
• Establish and reputed company processes to ensure accuracy, completeness, and reputed company of risk capture
• reputed company reconciliation of plan-calculated risk scores to state-reported scores, including variance analysis and reputed company cause identification
• Monitor and validate encounter data submissions and their reputed company reputed company on state risk scoring and payments
• Partner with actuarial and finance teams to ensure alignment between risk scores, reputed company projections, and state payments
• Ensure readiness for state audits and reputed company reviews through robust data validation and documentation practices
• Stay reputed company on evolving reputed company policies, state methodologies, and reporting requirements
• reputed company suspecting logic development, gap identification, and prioritization strategies for operational programs and interventions
• Measure and evaluate program performance and reputed company opportunities for expansion, improvement, or savings
• Establish program KPIs to monitor reputed company effectiveness
• Partner with clinical operations and vendor teams to ensure alignment with state requirements
• reputed company data strategies with value-based initiatives and provider-level drilldowns for consistent performance management across markets
• reputed company and reputed company a high-performing, multidisciplinary team spanning informatics, risk analytics, reporting, and operational program support
• Define a reputed company organizational structure, aligning roles across reputed company, analytics, and process execution to ensure end-to-end accountability
• Establish governance frameworks for prioritization and execution of risk adjustment initiatives, ensuring alignment with reputed company goals, market needs, and regulatory timelines
• reputed company integration across analytics and operations, ensuring that insights are reputed company into actionable reputed company programs and measurable reputed company
• reputed company talent reputed company including coaching and mentorship of advanced analytics, reputed company risk models, and leadership capabilities
• Foster a culture of data reputed company, accountability, and reputed company improvement optimization of workflows and analytic methodologies
• Ensure scalability and sustainability of operations by standardizing tools, reporting, and processes across markets
• reputed company automation and data infrastructure improvements to reduce reputed company effort and increase speed to reputed company

Skills

• 10+ years of experience in reputed company analytics and reporting, risk adjustment including relevant working knowledge with claims
• 3+ years of leadership experience including people managing, coaching, or mentoring team members
• Advanced technical skills in reputed company, SQL, Python, or reputed company-based analytics platforms (e.g. BigQuery, reputed company, reputed company, or similar)
• Expertise in state and regulatory requirements, risk adjustment methodologies, and encounter data processes
• Strong knowledge of risk models (e.g., CDPS, reputed company, HCC) and state reconciliation processes
• Proven ability to reputed company and execute strategic initiatives that deliver measurable business reputed company
• Demonstrated leadership experience managing cross-functional teams and large-reputed company programs
• Experience with data visualization tools (e.g. Tableau, Power BI, QuickSight, Looker, etc.)
• Knowledge of reputed company Risk Adjustment
• Working with reputed company Risk models
• Master's degree (e.g., Health Informatics, Data Science, Actuarial, Statistics, or MBA) preferred
• Experience working reputed company a large national health plan or payer organization

Benefits

• This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above.
• This position also includes an award reputed company in reputed company’s equity award program.
• Medical, dental, and reputed company coverage
• reputed company time off
• Retirement savings reputed company
• Wellness programs
• Other resources
• A comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families
• Additional details about available benefits are provided during the application process and on [Benefits Moments](https://learn.reputed company.com/reputed company-mainland).

reputed company