Risk

• Support the development and maintenance of Risk Adjustment related programs and reporting
• Aid in working with Risk Adjustment vendors for programs within all lines of business
• Aid in the development and support of company-wide Risk Adjustment initiatives within all product lines
• Assist in vendor management related to Risk Adjustment initiatives
• Help train providers and Health Plan staff in Risk Adjustment methodologies and activities
• Research and assist in development of best practices into operations for Risk Adjustment
• Prepare operational workflows specific to each product business requirements and local market dynamics
• Prepare and participate in meetings with various committees and providers
• Perform other duties as assigned

Risk Adjustment Specialist – Clinical

• Own enterprise data governance strategy, policy, and the federated stewardship model
• Co-chair the Data Governance Council with Quality Assurance
• Own metadata, business glossary, and end-to-end lineage across clinical, commercial, and corporate data
• Lead the data quality program and report domain scorecards to the executive team
• Own master data end to end across clinical, commercial, and regulatory domains
• Define GxP readiness for the data layer, including validated-zone criteria and boundaries
• Govern the data management practice and platform data layer
• Establish modeling standards and SLAs for certified data products
• Govern the CRO and vendor data supply chain
• Participate hands-on in architecture reviews, access model design, and data quality investigations
• Lead the commercial data foundation ahead of the US launch
• Govern controls behind transparency reporting and the commercial–medical firewall
• Oversee partner data interfaces for net sales, channel, and safety data exchange
• Establish data governance for AI, including provenance, model input controls, and EU AI Act readiness
• Translate Security, Legal, Privacy, Compliance, and QA obligations into implementable data controls

Risk jobs in Pennsylvania

Risk Adjustment Specialist – Clinical

Director, Enterprise Data Management – Governance Lead