• Enterprise Risk Adjustment

    LA Care Health Plan (Los Angeles, CA)
    Enterprise Risk Adjustment Analyst III Job Category: Accounting/Finance Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, ... required to achieve that purpose. Job Summary The Enterprise Risk Adjustment Analyst III provides...adjustment changes that regulatory bodies pass on to health plans as it relates to reimbursement reporting requirements.… more
    LA Care Health Plan (07/11/25)
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  • Risk Adjustment Actuarial…

    Elevance Health (FL)
    ** Risk Adjustment Actuarial Analyst II - Advanced Analytics** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days ... an accommodation is granted as required by law._ The ** Risk Adjustment Actuarial Analyst II...and New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package,… more
    Elevance Health (09/30/25)
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  • Senior Analyst , Healthcare Analytics…

    Molina Healthcare (NY)
    …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance.… more
    Molina Healthcare (07/17/25)
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  • Senior Risk Adjustment

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Senior ACA Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity ... of key risk adjustment performance metrics through coordination of... results and quality, accuracy and identification of member health conditions. Update, create and maintain business process and… more
    CareFirst (09/26/25)
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  • Professional, Sr. Risk Adjustment

    MVP Health Care (Rochester, NY)
    At MVP Health Care, we're on a mission to create a...To achieve this, we're looking for a **Professional, Sr. Risk Adjustment Analyst ** to join #TeamMVP. ... well-being + An opportunity to shape the future of health care by joining a team recognized as a...while achieving desired results required + Knowledge of CMS risk adjustment and reinsurance payment processes and… more
    MVP Health Care (09/21/25)
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  • Risk Adjustment Analyst

    Fallon Health (Worcester, MA)
    …fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Risk Adjustment Analyst (RAA) will be a SME for the ... MassHealth risk adjustment model(s) and related data submission...Attend meetings with Accountable Care Organiztions (ACOs) that Fallon Health shares risk with + Routinely run… more
    Fallon Health (09/06/25)
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  • Lead Data Analyst , Medicare Risk

    CareFirst (Baltimore, MD)
    … Analytics team is hiring a lead data analyst with deep experience in risk adjustment . This person will support the Director of Risk Adjustment ... & Qualifications** **PURPOSE:** The main purpose of a data analyst is to find meaning in data as a... by monitoring and reporting on risk adjustment KPIs, delivering insights for prospective and retrospective … more
    CareFirst (08/19/25)
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  • Medicare Advantage Risk Adjustment

    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 ... cycles. + Collaborate closely with Decision Support Services and Health Outcome & Analysis teams to transition ongoing reports...a key departmental resource for application use related to risk adjustment coding guidelines and gap closure… more
    UCLA Health (09/10/25)
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  • Business Process Analyst - Risk

    Highmark Health (Lansing, MI)
    …for efficiencies. May provide guidance to Associate level employees. **This role sits within our Risk Adjustment team - it is a remote based role - looking for ... some claims experience and looking to become familiar with risk adjustment .** **ESSENTIAL RESPONSIBILITIES** + Intake operational...3 - 5 years of experience in a Business Analyst or Business Process Analyst role or… more
    Highmark Health (09/24/25)
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  • Senior, Compliance Risk Adjustment

    Centene Corporation (Tallahassee, FL)
    …from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the ... for our 28 million members. Centene is transforming the health of our communities, one person at a time....compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way… more
    Centene Corporation (07/31/25)
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