Role Description The Senior Risk Adjustment (RA) Analyst assists in the accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services (CMS) for all risk adjustable populations. This position leverages available tools and knowledge of the applicable risk models to optimize data submission as it pertains to Hierarchical Condition Categories (HCCs), HEDIS® and Quality performance as well as other data within a given system. The Senior RA Analyst will collaborate and coordinate with internal and external partners to minimize submission and response errors, provide thorough oversight of vendor partners, accumulate, and report out on pertinent data sets, develop and improve processes related to risk adjustment and quality improvement, maintain required documentation, and ensure compliance to all applicable laws, guidance, and regulations. Assume lead role on specified projects. Projects are completed with cross-functional teams of peers and business partners. This includes interaction with provider partners with the intent of informing them on performance and educating on best practices in risk adjustment. The Senior RA Analyst will provide mentorship to less experienced team members. In addition, this position influences decision making by leadership and provides recommendations regarding potential improvements to risk adjustment processes and outcomes. Qualifications - Five years’ experience in data analytics or software development required. - At least three years’ experience in Health Plan required. - In-depth risk adjustment and/or HEDIS® experience required. - Expertise in Microsoft Excel and SAS/SQL is required. - Experience in leading projects and project teams required. - Familiarity with Medicaid risk adjustment and CMS 5-Star required. - Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred. - Equivalent work and education experience will be considered. Requirements - Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required. - Advanced degrees preferred. - Expert-level analytical and problem-solving abilities are required. - Mastery of theories and applications of computer programming required. - Ability to keep current with changing technologies. - Excellent communication skills, both verbal and written. - Ability to establish and maintain effective work relationships. - Read, understand, and interpret documents of complex subject matter. Benefits - Compensation range: $74,601.93 - $126,822.77. - Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Environment - Work inside in a general office setting with ergonomically configured equipment. - Travel is required approximately 20% of the time with some overnight travel. Skills - Accountability - Collaboration - Communication (written/verbal) - Flexibility - Listening (active) - Organizational skills/Planning and Organization - Problem Solving - Teamwork Physical Requirements - Stoop and bend. - Sit and/or stand for extended periods of time while performing core job functions. - Repetitive motions to include typing, sorting and filing. - Light lifting and carrying of files and business materials. - Ability to read and comprehend both written and spoken English. - Communicate clearly and effectively. Disclaimer This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

• Engages with underwriting to drive corporate strategies for targeted lines of business • Optimizes distribution engagement, strengthening relationships with agents and brokers • Analyzes risk control strengths and weaknesses • Develops risk control strategies to positively impact loss ratios and achieve profitability targets • Supports branch(s) or territory with technical expertise • Works across the BUs to review and direct the evaluation and assessment of large and complex risks • Influences the direction, development and implementation of risk control policy • Develops and maintains business relationships with internal and external business partners

Role Description Solid understanding of Data Structures and Algorithms, with practical exposure to Generative AI concepts and applications. - Proven experience in developing and deploying Java and generative AI models. - Excellent communication and collaboration skills. - Demonstrated problem-solving ability with a strong engineering mindset and attention to scalable, high-quality solutions. Qualifications - Minimum 7+ years of hands-on experience in software development. - Solid understanding of Data Structures and Algorithms, with practical exposure to Generative AI concepts and applications. - Experience with Large Language Models (LLMs) and understanding of Retrieval-Augmented Generation (RAG) frameworks. - Strong experience in Database Management, including hands-on work with SQL and Relational Database Management Systems (RDBMS). - Experience in Java, with strong expertise in Spring Framework / Spring Boot, building RESTful APIs, and working within Microservices architecture. Benefits - Flexible work arrangements to support work-life balance, including remote work and flexible hours. - Career growth programs and diverse professions to explore a world of opportunities. - Valuable certifications in the latest technologies such as Generative AI. Company Description Capgemini is a global business and technology transformation partner, helping organizations to accelerate their dual transition to a digital and sustainable world, while creating tangible impact for enterprises and society. - A responsible and diverse group of 340,000 team members in more than 50 countries. - Strong over 55-year heritage, trusted by clients to unlock the value of technology. - Delivers end-to-end services and solutions leveraging strengths from strategy and design to engineering. - Market-leading capabilities in AI, generative AI, cloud and data, combined with deep industry expertise and partner ecosystem.

Role Description The Principal, Risk Adjustment, is a director-level strategic leader responsible for cross-functional collaboration to drive enterprise risk adjustment performance, supporting new market acquisition and expansion, and leading high-impact, scalable program initiatives from concept through execution. This role provides leadership across risk adjustment strategy, trend management, provider engagement, operational execution, compliance, vendor oversight & technology enablement. The role will drive cost saving measures, improve operational efficiencies, and increase provider engagement and regulatory compliance. Essential Functions - Strategic Leadership & Market Expansion: - Lead risk adjustment strategy for new market acquisition, expansion, and operational readiness. - Assess market-specific risk adjustment opportunities, operational gaps, provider capabilities, and technology requirements. - Develop & execute scalable risk adjustment playbooks for new & existing markets. - Partner with executive leadership & cross-functional stakeholders to align risk adjustment strategies with enterprise growth, revenue integrity, quality & value-based care objectives. - Ensure department policies, programs, and plans are consistent with and support Priority Health’s core values and mission. - Program Development & Execution: - Lead risk adjustment initiatives from ideation & business case development through implementation, monitoring & continuous improvement. - Define program objectives, success metrics, timelines, resource needs, risks, and operational dependencies. - Oversee & support implementation of prospective, concurrent & retrospective risk adjustment programs. - Drive process standardization across markets and vendors. - Monitor initiative performance & develop corrective action plans to close gaps in execution or outcomes. - Trend Management & Performance Oversight: - Lead trend management for all risk adjustment initiatives, including development, implementation, monitoring, reporting, and optimization. - Analyze trends and financial impacts and make recommendations for gap closure. - Partner with Analytics & Actuary teams to forecast performance, identify improvement opportunities, and quantify revenue impact. - Develop executive-level reporting & dashboards to track performance against targets. - Identify emerging risks, market variation, provider performance issues, data gaps, and operational barriers impacting risk adjustment outcomes. - Provider Engagement & Technical Enablement: - Lead implementation of provider-facing technical applications and workflows that support risk adjustment accuracy and documentation improvement. - Partner with IDA/DS, Analytics, Clinical Operations, and external vendors and providers to integrate risk adjustment tools into EMR/EHR platforms and provider workflows. - Ensure provider facing tools are scalable across markets. - Collaborate with Provider Network and external providers to support adoption, training, workflow redesign and performance accountability. - Operational Governance & Compliance: - Establish governance, controls, and monitoring processes for risk adjustment initiatives & technology-enabled workflows. - Ensure risk adjustment activities comply with CMS requirements, coding guidelines, documentation standards, HIPAA, and internal compliance policies. - Partner with Compliance and Audit teams to support RADV readiness, internal audits, chart review governance, and remediation plans. - Develop policies, procedures, operating models, and controls to support sustainable & compliant risk adjustment operations. - Cross-Functional Leadership: - Partner with market leadership, provider engagement, clinical operations, finance, actuarial, analytics, compliance, IDA/DS, product and vendor partners. - Influence stakeholders across a matrixed organization to drive alignment, accountability, and execution. - Lead steering committee updates, executive briefings, and cross-functional workgroups. - Translate complex risk adjustment insights into actionable business strategies & operational priorities. - Provide leadership, coaching, and direction to project teams, analysts, market partners, and operational stakeholders. - Vendor & Partner Management: - Lead and participate in evaluating, selecting and managing vendors supporting risk adjustment. - Support defining vendor performance expectations, service-level metrics, implementation timelines, and quality standards. - Monitor vendor outcomes, resolve issues, and ensure alignment with enterprise objectives and compliance requirements. - Partner with procurement, legal, compliance, and finance on contracting, performance reviews, and ongoing governance. Qualifications - Bachelor's Degree in business, health care administration or related clinical field. (Required) - Master's Degree in business, health care administration or related clinical field. (Preferred) - 12 years of relevant experience. - Strong Risk Adjustment and Project Management experience with a detailed understanding of Enterprise Risk Management & Risk Adjustment for MA & ACA LOB. (Required) - CRT-ScrumMaster, Certified (CSM) - Required. - CRT-Lean Six Sigma Black Belt Certification (CSSBB) - Preferred. - CRT-Project Management Professional (PMP) - PMI - Preferred. Physical Demands - Pallet to Waist (6" from floor) > 5 lbs: Seldom - Waist to Waist > 5 lbs: Seldom - Waist to Chest (below shoulder) > 5 lbs: Seldom - Waist to Overhead > 5 lbs: Seldom - Bilateral Carry > 5 lbs: Seldom - Unilateral Carry > 5 lbs: Seldom - Pushing Force > 5 lbs: Seldom - Pulling Force > 5 lbs: Seldom - Sitting: Frequently - Standing: Occasionally - Walking: Occasionally - Forward Bend - Standing: Seldom - Forward Bend - Sitting: Occasionally - Trunk Rotation - Standing: Seldom - Trunk Rotation - Sitting: Occasionally - Reach - Above Shoulder: Seldom - Reach - at Shoulder or Below: Seldom - Handling: Occasionally - Forceful Grip > 5 lbs: Seldom - Forceful Pinch > 2 lbs: Seldom - Finger/Hand Dexterity: Frequently Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.