Manager, Risk Management – Business Team

Cambia Health Solutions

. Lead the Risk Management Business Team responsible for CMS-mandated Enrollment, Medical Claim and Pharmacy Claim data submissions for Reinsurance and Risk Adjustment programs .

Posted 9/29/2026full-timeUnited StatesSeniorLead💰 $104,000 - $171,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Risk Management, Data Analysis, and Project Management, with a strong focus on compliance and operational efficiency. Capable of leading teams, developing policies, and communicating complex information effectively across various departments.

Highest-signal resume keywords

Risk Adjustment Systems KnowledgeData Analysis ExperienceProject Management ProcessesMedical Terminology ProficiencyTeam Leadership and Development

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data AnalysisProcess ModelingProject ManagementMedical Underwriting Rules DevelopmentAudit Process ImplementationData Submission System OversightValidation ChecksBusiness Requirements DocumentationComplex Data AnalysisSynthesis of Solutions

Soft Skills

Analytical SkillsProblem-Solving SkillsEffective CommunicationStaff DevelopmentCollaboration

Tools & Technologies

AI Tools and TechnologiesCMS Edge ServerData Submission Systems

Industry Keywords

Risk ManagementReinsuranceRisk Adjustment ProgramsRADV AuditsMedical Claim DataPharmacy Claim DataEnrollment DataCompliance Standards

About the role

Key responsibilities & impact

Lead the Risk Management Business Team responsible for CMS-mandated Enrollment, Medical Claim and Pharmacy Claim data submissions for Reinsurance and Risk Adjustment programs
Lead extraction of required information from source systems into a staging area
Oversee validation checks based on CMS Edge Server Business Rules
Submit correct data to the Edge Server through a translation process
Collaborate with IT, compliance, legal, revenue management, claims, enrollment, product and other departments
Oversee RADV audits, submit data timely and prepare executive reports
Develop medical underwriting rules for the Risk Management business system
Direct business projects and deliver project performance criteria and objectives
Support day-to-day operations, identify issues and recommend solutions
Develop and review business policies, processes and practices
Develop, implement and monitor audit processes for Edge Server utilization
Create and deliver training materials
Partner with IT to resolve data submission system issues
Manage staff development, performance conversations, coaching and retention activities
Communicate departmental and organizational goals to staff
Maintain departmental policies and procedures and ensure adherence to standards
Oversee the data submission system
Travel rarely, locally or out of state

Requirements

What you’ll need

Bachelor’s degree in Business, Data Analysis or another related field
10 years’ experience with data analysis, process modeling or equivalent combination of education and experience
Strong analytical skills, including analyzing complex data and synthesizing solutions, options and action plans
Ability to understand, translate and communicate complex ideas to varied audiences
Excellent research and problem-solving skills
Strong knowledge of risk adjustment systems and processes
Experience working with business requirements, documentation and data systems
Strong knowledge of project management processes and practices
Experience leading large, complex initiatives
Knowledge of medical terminology and procedure coding
Ability to communicate effectively verbally and in writing with all levels of staff
Ability to develop and lead a team, including hiring, goal setting, motivating, coaching and staff development
Experience with AI tools and technologies highly desired
Must have access to a personal mobile device for MFA
Background check required

Benefits

Comp & perks

Competitive base pay
Market-leading 401(k) with a significant company match
Bonus opportunities
Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
Annual employer contribution to a health savings account
Generous paid time off varying by role and tenure
10 company-paid holidays
Retirement plan with potential discretionary contribution based on company performance, with no vesting period
Up to 12 weeks of paid parental time off after 12 months of continuous service
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work from home options for most roles, subject to wired internet requirements
Employee resource groups
Cambia-supported community outreach programs
Personal mobile device access for Multi-Factor Authentication