Health Care Service Corporation logo
Health Care Service Corporation

Empowering Whole Person Health With Compassion and Innovation

Manager, Medicare Risk Adjustment Analytics Consulting

Location

Tennessee

Posted

17 days ago

Salary

$112.2K - $202.6K / year

Seniority

Senior

Bachelor Degree5 yrs expExperience acceptedEnglish

Job Description

Manager, Medicare Risk Adjustment Analytics Consulting

Health Care Service Corporation

• Drive revenue integrity and analytics strategy by consulting on strategic initiatives • Lead cross-functional teams and collaborate with risk adjustment analysts • Transform complex financial and risk adjustment data into actionable business intelligence • Champion advanced data science initiatives by developing predictive models • Deliver strategic, data-driven insights and collaborate with stakeholders on revenue accuracy

Job Requirements

  • Bachelor Degree in Math, Actuarial Science, Business Statistics, Accounting or Finance OR 4 years experience
  • 5 years experience interfacing with external clients, large employers, brokers, or consultants OR 5 years experience in presenting analytic results to both internal and external audiences
  • 5 years experience in requiring data analysis and information reporting related to healthcare data
  • 2 years leadership experience
  • Negotiation, decision-making, organizational, and analytical skills
  • Verbal and written communication skills, including presentation skills
  • PC proficiency to include Access, Excel, Word, and PowerPoint

Benefits

  • Health and wellness benefits
  • 401(k) savings plan
  • Pension plan
  • Paid time off
  • Paid parental leave
  • Disability insurance
  • Supplemental life insurance
  • Employee assistance program
  • Paid holidays
  • Tuition reimbursement

Related Categories

Related Job Pages

More Risk Jobs

Full TimeRemoteTeam 1,001-5,000H1B No Sponsor

• Responsible for supporting and enhancing the organization's Fraud Risk Management and Operations program, with primary oversight of fraud alert monitoring (Level 1) and fraud case investigations (Level 2). • Ensures effective detection, investigation, escalation, and resolution of fraud-related activity across products and channels, while maintaining alignment with applicable regulatory requirements, including BSA/AML where applicable. • Support the development, implementation, and maintenance of comprehensive fraud detection, alert management, and investigation procedures and controls. • Manage and oversee team responsible for: Level 1: Fraud alert review, triage, and disposition; Level 2: Fraud case investigation, escalation, and resolution. • Establish and monitor quality standards, productivity expectations, and SLAs for alert handling and case investigations. • Assist in overseeing applicable components of the BSA/AML program, including suspicious activity identification and escalation, when fraud activity meets SAR reporting thresholds. • Partner with cross-functional teams (e.g., Risk, Compliance, Product, Operations) to enhance fraud detection strategies, rules, and controls. • Participate in risk assessments to identify and evaluate fraud risks across products, channels, customer segments, and emerging typologies. • Collaborate with senior leadership to develop and execute strategic initiatives that enhance fraud detection effectiveness, investigative quality, and operational efficiency. • Drive continuous improvement in alert-to-case workflows, including automation, documentation standards, and escalation protocols. • Other duties as assigned

Arizona + 5 moreAll locations: Arizona | Kentucky | Michigan | Pennsylvania | South Dakota | Tennessee
$72K - $120K / year
Paschoalotto logo

Analista de Governança de TI

Paschoalotto

Somos parte da solução para pessoas, empresas e comunidade.

Risk17 days ago
Full TimeRemoteTeam 10,001+Since 1998H1B No Sponsor

• Irá atuar no Gerenciamento de Incidentes e Requisição abertos na ferramenta de ITSM; • Monitorar as filas de atendimento realizando o Ticket Audit e Review; • Realizar os Comitês de Incidentes e Requisição e responsável pelo envio de ATA; • Realizar melhorias e atualização no catálogo de serviços e grupos solucionadores de incidentes e requisição; • Manter o documento de processo atualizado e realizar criação de IOPs do processo; • Realizar revisões de SLA e implantar melhorias; • Construir, atualizar e analisar Indicadores das áreas da T.I com base nos tickets abertos na ferramenta de ITSM;

Brazil
Mashreq logo

Assistant Manager – Model Risk Management

Mashreq

We are Mashreq - Inspiring you to Rise Every Day

Risk17 days ago
Full TimeRemoteTeam 1,001-5,000Since 1967H1B No Sponsor

• Assist in end-to-end management of model risk within Mashreq group • Focus on model validation and its related activities • Work on PD, EAD, LGD and Macroeconomic models from Credit Risk • Work on VaR/PSRE/CVA/FRTB models from Market Risk • Regular interaction and working relationships with departments like Wholesale Risk Management, Retail Risk Management, and Market & Operational Risk Management • Assisting in managing model risk governance issues and integrity • Measurement of key model performance metrics, risk capital etc. • Preparing model performance related reports for senior stakeholders

Pakistan
Job Closed
Full TimeRemoteTeam 1-10H1B No Sponsor

• Own the fraud rule lifecycle — designing, testing, deploying, and continuously optimizing detection rules and thresholds to maximize catch rate while minimizing friction. • Lead AI-enabled fraud use cases end-to-end: use-case sizing, feature ideation, population analysis, and data quality assessment to ensure solutions are analytically sound and value-accretive. • Conduct periodic performance reviews of fraud models and rules; drive root-cause investigations to proactively surface risk before it scales. • Serve as a trusted advisor for AI and ML use cases within fraud, ensuring alignment with enterprise AI governance standards, regulatory expectations, and the AI Use Case Registry. • Evaluate vendor fraud solutions through an analytical lens — assessing effectiveness, overlap, and value relative to cost and risk-reduction objectives. • Stay current on AI and automation tools and actively explore how they can enhance fraud detection workflows and efficiency. • Write and maintain intermediate-to-advanced SQL queries to investigate fraud signals, identify connected accounts and orders, and surface emerging patterns. • Develop and maintain executive dashboards covering fraud review rates, chargeback performance, model effectiveness, and loss trends. • Translate complex analytical findings into clear, executive-ready narratives — articulating implications for fraud loss, operational efficiency, and customer experience. • Proactively identify trends and anomalies at both the individual order and systemic level, communicating the full arc of a problem — from discovery to resolution — to any audience. • Support daily fraud review operations — account verification, order review, escalation handling, SLA adherence, and QA. • Serve as an internal escalation point for complex cases; assist in coaching the team and continuously improve review processes. • Partner cross-functionally with Product, Engineering, Compliance, and Legal to align fraud controls with regulatory requirements and product priorities. • Manage law enforcement requests as needed.

California + 1 moreAll locations: California | New York
$104.5K - $153.6K / year