• Lead Data Analyst, Medicare Risk

    CareFirst (Baltimore, MD)
    …leadership roles. + Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical,submission cycle, and financial ... the organization in making better business decisions. The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience… more
    CareFirst (08/19/25)
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  • Senior Actuarial Analyst ( Medicare

    Molina Healthcare (Tampa, FL)
    **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. + Analyze… more
    Molina Healthcare (07/25/25)
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  • Medicare Risk Adjustment

    Elevance Health (Grand Prairie, TX)
    ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration ... dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible for creating… more
    Elevance Health (08/16/25)
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  • Consulting Actuary - Medicare Risk

    BlueCross BlueShield of North Carolina (NC)
    …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + ... The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and… more
    BlueCross BlueShield of North Carolina (09/05/25)
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  • Medicare Advantage Risk

    UCLA Health (Los Angeles, CA)
    Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... Serve as a key departmental resource for application use related to risk adjustment coding guidelines and gap closure reporting. Salary Range: $78,500 -… more
    UCLA Health (09/10/25)
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  • Senior Risk Adjustment Analyst-…

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of CMS risk score… more
    CareFirst (09/26/25)
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  • Medicare Risk Adjustment

    TEKsystems (Sunrise, FL)
    …Job Description Position Purpose: Schedule appointments gather medical histories and updated member and provider information in support of member outreach and claims ... reimbursement. Education/Experience: High school diploma or equivalent. 0-2 years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Responsibilities:… more
    TEKsystems (09/24/25)
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  • Medicare Risk Adjustment

    TEKsystems (Sunrise, FL)
    …The Medical Records Coordinator is responsible for scheduling appointments, gathering medical histories, and updating member and provider information to support ... member outreach and claims reimbursement. Responsibilities + Assist members with scheduling office visits with primary care providers. + Retrieve charts from electronic medical record systems and compile medical records for coding purposes. + Make outbound… more
    TEKsystems (09/20/25)
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  • Medicare Risk Adjustment

    TEKsystems (Sunrise, FL)
    …- Provide support for the Quality Department to perform improvement and review procedures. - Conduct internal record reviews and audits, including medical records. - ... Review records to ensure they are complete, accurate and compliant with standards Initiate SOP revisions to ensure they are current and validated and support continuous improvement - Develop and enhance documentation, tracking tools and process flows for… more
    TEKsystems (09/16/25)
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  • Health Care Disputes - Compliance Risk

    Ankura (New York, NY)
    …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
    Ankura (09/09/25)
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