Senior Risk Adjustment Analyst
Jobtailor
Conduct advanced data analysis Build and maintain HCC performance reporting Support predictive modeling initiatives Monitor vendor performance Design, develop, and maintain risk adjustment performance dashboards and reports using Power BI, Tableau, or equivalent tools to monitor KPIs Write and optimize complex SQL queries to extract, transform, and analyze large datasets Support the development and validation of predictive models for HCC suspecting, risk score forecasting, and provider performance stratification Prepare and present analytical findings, trend analyses, and performance summaries to key internal stakeholders Mentor junior analysts and coordinators Maintain active relationships with customers to determine business requirements Requirements Requires an BA/BS degree in Information Technology, Computer Science or related field of study Minimum of 5 years experience with multi platform, two or more BI applications and/or multiple Business Intelligence tools required Medicare Advantage or commercial Risk adjustment data analysis experience is a must have SQL experience strongly preferred Intermediate Excel experience preferred Power BI experience is nice to have Hard Skills data analysis predictive modeling SQL Excel Power BI Tableau risk adjustment KPI monitoring data extraction data transformation Soft Skills mentoring communication relationship management presentation skills analytical thinking #J-18808-Ljbffr Jobtailor
- ...creating a better care experience for all. SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine... ...Analytics in a Value-Based Care Setting. The Risk Adjustment Analyst will be the lead in the design, implementation, and maintenance...Suggested
- Blue Cross Blue Shield of Nebraska seeks a Healthcare Analytics professional to support the Risk Adjustment Programs by analyzing healthcare data to evaluate program performance, measure financial and clinical impact, and identify opportunities for improvement. The role...SuggestedRemote job
- The Healthcare Analytics role supports the Risk Adjustment Programs team by analyzing healthcare data to evaluate program performance,... ...analytic solutions on ad‑hoc requests with little oversight by senior analysts. To be considered for this position, you must have:...SuggestedLive inRemote work
- Mount Sinai Medical Center of Florida, Inc. is seeking a Certified Risk Adjustment Coder to ensure accurate coding and documentation standards. The role involves reviewing medical records, providing feedback to physicians, and maintaining coding credentials. The ideal candidate...Suggested
- Centrumhealth is seeking a Risk Adjustment Analyst responsible for designing and maintaining Risk Adjustment and Quality Data for the entire portfolio. This role requires strong SQL skills and experience in healthcare analytics. The position involves collaboration across...Suggested
$128k - $150k
Unchain Data is looking for a Senior Technical Risk Analyst to lead risk management efforts, coordinate issue management programs, and ensure effective governance. The position requires 5-10 years of related experience and technical fluency in SQL and Python in New York...Senior- ...provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities. Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional...
- Responsibilities Responsible for assessing and managing technical risks across the organization’s IT and operational environments Works closely with cross-functional teams to identify and analyze emerging technology risks, implement risk management strategies, and maintain...Senior
- NextEra Energy Resources in New York is looking for a Principal Regulatory Investigation Analyst to manage regulatory inquiries and compliance events. This role involves coordinating with business units to address regulatory issues and ensure compliance with energy regulations...Senior
$99k - $117k
...Expectations are high, and so are the rewards. Brokerage Risk, Strategy & Execution empowers Robinhood to boldly innovate... ...operational workflows, and real-time decision-making. As Senior Technical Risk Analyst, you will be responsible for executing the various...SeniorWork at officeShift work3 days per week- Cannon Cochran Management Services, Inc. is seeking an experienced Workers’ Compensation Claim Adjuster to manage claims with professionalism and technical skill. This hybrid role, based in Maitland, FL, requires 5-10 years of experience and offers opportunities for career...SeniorRemote job
- Allstate Insurance Company is seeking an Attorney‑Represented Bodily Injury Claims Adjuster in the Town of Florida, New York. The position is geared towards experienced adjusters who can manage complex claims effectively while driving strong outcomes within a fast-paced...Senior
- ...Davies Talent Solutions has partnered with a respected organization to bring on an experienced Senior Property Claims Adjuster to handle residential and commercial property claims . This is an on-site role based in either Orlando or Sarasota, FL. About This Role This role...SeniorFor contractors
- ...experience in a variety of technologies Documenting requirements and/or building test cases Medicaid experience is a must Business Analyst or Business Systems Analyst certifications strongly preferred Experience with mainframe computer, hardware and operating systems...
- CVS Health is seeking a Senior Informatics Manager to join the Risk Adjustment Analytics team in the Town of Florida, New York. The role focuses on leading complex data analyses and ensuring compliance with healthcare regulations. The ideal candidate will have extensive...Senior
- Ccmsclaims is seeking a homeowners liability desk adjuster in the Town of Florida, NY, with at least 5 years of experience. The position is available immediately. The ideal candidate will perform in-depth investigations on liability claims, help maintain an active caseload...SeniorImmediate start
- Jobtailor is seeking an experienced data analyst to conduct advanced data analysis and drive performance reporting for HCC and risk adjustment initiatives. The role involves developing dashboards, modeling support, and SQL-driven data extraction for large datasets. You...Senior
- ...efficiency, and strategic litigation planning across jurisdictions. The ideal candidate has a decade of litigated claims experience, an adjuster license, and deep knowledge of Florida construction defect, coverage issues, and policy language interpretation. #J-18808-Ljbffr...Senior
$75k - $92k
A leading insurance firm is seeking a Workers Comp Adjuster for a fully remote position within the USA. The role demands at least 9 years of experience in property and casualty claims handling, along with a bachelor's degree in a relevant field. Responsibilities include...SeniorRemote job$105k - $135k
Our client is seeking to add a Construction Defect Adjuster to their team. The ideal candidate will have a minimum of 6 years experience handling Litigated Construction Defect claims from cradle to grave. This position is remote. Required Qualifications 6 years experience...SeniorLocal areaRemote work- PacificSource is seeking a Senior Risk Adjustment Analyst to enhance data submission accuracy for CMS and optimize risk models. The role requires collaboration with internal and external partners, ensuring compliance with regulations, and mentoring less experienced analysts...SeniorRemote job
- ...BankUnited is seeking a motivated, self-starting Analyst to join the Third Party Risk Management team. In this highly visible role, the Third Party Risk Analyst will be responsible for identifying, analyzing and influencing the management of third party risks across the...SeniorWork experience placement
- BNY is seeking a Senior Specialist, Control based in Lake Mary, Florida. This role focuses on identifying and managing platform risks, enhancing operational governance, and ensuring compliance by delivering effective RCSA execution. The ideal candidate has strong problem...Senior
- JobTailor in New York is seeking a seasoned Risk Manager to lead operational risk, controls, and compliance initiatives within a banking/financial services environment. You will coordinate risk assessments, QA processes, and remediation efforts across multiple lines of...Senior
- ...Enablement Control team in Lake Mary, FL. This position involves providing compliance support, enhancing controls, and collaborating with Risk and Compliance units. The ideal candidate holds a Bachelor’s degree with 3-5 years of experience in Financial Services or related...Senior
$53.5k - $86.4k
...and confirming the facts of loss for the most complex automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within the limit of authority. Mentors and provides direction to junior employees. Key Responsibilities Recognizes...SeniorRemote jobWork from home- Responsibilities Provides a comprehensive and diverse range of risk management expertise to business leaders. Leads and supports the... ...industry best practices. Serves as a source of expert advice to senior management in field of specialty; may lead team(s) of related specialists...Senior
- Fairygodboss is looking for a Risk & Safety Consultant to provide loss control and workplace safety consultation to clients. This role involves assessing client safety measures and ensuring compliance with OSHA regulations through onsite visits and training. The ideal...Senior
$20 per hour
A healthcare technology firm based in the United States is seeking a Risk Adjustment Analyst to enhance AI models by evaluating their logic and performance. The ideal candidate will be an expert in healthcare with a strong background in areas like Revenue Cycle Management...Hourly payFor contractorsRemote work- ...media search results, results from internal system searches, etc.) and prepare cases for review and approval by management. Provide risk rating recommendations to management for clients’ relationships reviewed, by determining if client is low or potentially high risk...Senior
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