Mgr, Risk Adjustment Operations

Gather and organize status of operational activities across the risk adjustment department.

Participate in or lead internal or external project workgroup(s) and presentations.

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 department leadership.

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.

Support management through ad hoc reporting and special projects.

Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Bachelor degree preferred or relevant experience in lieu of degree.

Minimum of six (6) years’ experience with at least four (4) years’ experience in a project support or analysis role.

Requires people management experience.

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.

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.