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Mgr, Risk Adjustment Operations -

Company: Horizon Blue Cross Blue Shield of New Jersey
Location: Newark
Posted on: February 16, 2020

Job Description:

Job Summary:This position will lead the coordination of analytics and process functions within the Enterprise Risk Adjustment department and will work with functional leaders to gather input and improve processes in order to achieve organizational objectives. The Risk Adjustment Operations Manager will directly support the Vice President providing reporting and business insights, generating presentation materials for external groups, and identifying process improvement opportunities. This position will also be responsible for the enterprise risk adjustment education program: developing materials, scheduling sessions, and performing educational activities to increase the level of risk adjustment knowledge at Horizon. Furthermore, this role will work with divisional and business unit leaders across the enterprise to facilitate and manage risk adjustment alignment activities for those departments. This is senior level position that receives minimal guidance and requires a self-motivated individual.


  • Gather and organize status of operational activities across the risk adjustment department.
  • Identify operational issues then develop and implement solutions with key stakeholders across Horizon and the risk adjustment department.
  • Participate in or lead internal or external project workgroup(s) and presentations.
  • Facilitate internal and external audit processes including documentation and process management for the risk adjustment department.
  • 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 the vice president and department leadership.
  • Develop, implement, and manage an enterprise education program for risk adjustment by developing and updating materials, scheduling sessions, and tracking progress.
  • 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.
  • Manage the department and vendor budgets for risk adjustment.
  • Support management through ad hoc reporting and special projects.

    Education:

    • Requires a bachelor's degree from an accredited college or university.
    • Minimum of six (6) years' working experience in any role with at least five (5) years' experience in a project support or analysis role.
    • 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.
    • Some travel may be required.

Keywords: Horizon Blue Cross Blue Shield of New Jersey, Newark , Mgr, Risk Adjustment Operations -, Other , Newark, New Jersey

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