Risk Adjustment Program Lead

Capital Blue Cross

. Analyze program results against operating plans and targets, investigate variances, and coordinate actions to address risks and opportunities .

Posted 10/22/2026full-timeRemote • Pennsylvania • United StatesSenior💰 $75,400 - $140,020 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in program analysis, performance measurement, and operational reporting within the healthcare industry, with a strong focus on risk adjustment programs and stakeholder coordination. Proficient in utilizing data validation techniques and advanced Excel skills to enhance reporting processes and workflows.

Highest-signal resume keywords

Risk Adjustment Program ExperienceHealthcare Industry KnowledgeAdvanced Excel SkillsProject CoordinationPerformance Measurement

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 ValidationOperational ReportingPerformance MeasurementVariance AnalysisFinancial ConceptsDashboards DevelopmentReporting Processes ImprovementVendor Performance MonitoringAgile Environment AdaptabilityStakeholder Coordination

Soft Skills

Analytical SkillsProblem-SolvingWritten CommunicationVerbal CommunicationMeeting Facilitation

Tools & Technologies

Microsoft OfficePower BIBusiness Intelligence Tools

Industry Keywords

Medicare AdvantageACA Risk Adjustment ProgramsRegulatory RequirementsHealthcare OperationsVendor Evaluations

About the role

Key responsibilities & impact

Analyze program results against operating plans and targets, investigate variances, and coordinate actions to address risks and opportunities
Develop and maintain dashboards, recurring reports, performance measures, and vendor scorecards
Validate data and metric definitions to ensure accurate, consistent, and useful reporting
Maintain program planning inputs and assumptions, track changes, and flag issues affecting projected results
Coordinate with Finance and Actuarial partners
Own initiatives from initial analysis through implementation and completion
Establish deliverables and milestones, coordinate stakeholders, track progress, address or escalate barriers, and confirm results
Plan and facilitate program performance and workstream meetings
Monitor vendor performance and deliverables, investigate variances, coordinate follow-up, and escalate unresolved issues
Support vendor evaluations and proof-of-concept initiatives
Monitor CMS and other regulatory developments, guidance, and deadlines
Partner with Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance, and vendors
Prepare reports, presentations, and updates on program results, emerging issues, and recommendations
Improve reporting processes, workflows, and tracking tools

Requirements

What you’ll need

High School Diploma required
Bachelor’s degree in business administration, Economics, Finance, Health Care, Information Systems, Public Health, Statistics, Mathematics, or a related field
3 years of healthcare industry work experience, or 6 years of relevant experience in lieu of degree
2 years of Risk Adjustment Program or Operations work experience
Working knowledge of Medicare Advantage and ACA risk adjustment programs, operational processes, and payment methodologies
Understanding of performance measurement, data validation, and operational reporting
Working knowledge of financial concepts, including budgets, forecasts, and variance analysis
Familiarity with regulatory requirements and their implications for risk adjustment operations
Experience coordinating projects or workstreams involving multiple stakeholders and deadlines
Proficiency in Microsoft Office applications, including advanced Excel skills
Experience with Power BI or other business intelligence tools preferred
Ability to independently manage assignments and initiatives
Strong analytical, problem-solving, written, verbal communication, organization, documentation, and meeting facilitation skills
Ability to build effective working relationships and coordinate across internal departments and external vendors
Ability to work in an agile and dynamic environment
Ability to occasionally lift or move up to 5 pounds

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Flexible work environment
Training and continuing education
Community volunteering opportunities