Manager Data Risk Adjustment

4 days ago


Houston, United States System One Full time

System One is working with a large health insurance organization that is seeking a qualified Manager level candidate to oversee their Data Risk and Analytics team. This individual will have direct responsibilities to conduct and oversee risk assessment and data analytics to ensure compliance and quality are adhered. Individuals with experience in healthcare or insurance industries as well as possessing a degree in Mathematics, Actuarial Science, Economics, or Statistics is preferred. This position is a permanent, full time opportunity offering full benefits, PTO and robust retirement plan packages. While it is preferred the person relocate to the Tulsa, Oklahoma area, there is an opportunity for this to be a remote role based on availability for the candidate to travel on site as needed.

Responsibilities: Organizes and lead the team responsible for risk score tracking and improvement.
Maintains internal risk adjustment models using published documentation.
Manages projects, including creating and leading a team of analysts, interaction with other departments and outside parties. Perform quality review of work product produced by assigned analysts.
Conducts major analytical projects without immediate supervision, including all aspects from programming to analyzing and abstracting information into written reports and possible oral presentation.
Oversees training of new analysts and professional development of supervised analysts.
Supervises and performs advanced analytical modeling. Oversees provider contract modeling.
Facilitates submission of encounters to regulatory agencies.
Oversees other data submission to regulatory agencies.
Perform other duties as assigned.

Qualifications: Ability to conduct concurrently multiple analyses without immediate oversight.
Ability to manage multiple projects, including creating and leading a team of analysts, interaction with other departments and outside parties.
Ability to apply advanced actuarial, mathematical and statistical techniques and principles into the analysis of financial and health related data.
Possess strong oral and written communication skills.
Successful completion of Health Care Sanctions background check.
Proficient in Microsoft Office applications.
Bachelor’s degree in Mathematics, Statistics, Economics, Actuarial Science required.

Proficiency in SAS, SQL, or other Analytical Software.
6 plus years analytical experience; preferably in a Managed Care or Healthcare environment.
4-6 years management experience strongly preferred.
Experience with various risk adjustment models including the CMS Medicare model, CMS ACA Model and 3rd party software strongly preferred.



  • Houston, TX, United States System One Full time

    System One is working with a large health insurance organization that is seeking a qualified Manager level candidate to oversee their Data Risk and Analytics team. This individual will have direct responsibilities to conduct and oversee risk assessment and data analytics to ensure compliance and quality are adhered. Individuals with experience in healthcare...


  • Houston, Texas, United States Baldwin Risk Partners Full time

    Job Title: Sr Client Service Specialist, Commercial RiskThe Baldwin Group, a leading insurance brokerage firm, is seeking a highly skilled Sr Client Service Specialist to join our team. As a key member of our commercial risk management team, you will play a critical role in delivering expertly crafted insurance and risk management solutions to our...


  • Houston, Texas, United States Baldwin Risk Partners Full time

    Job SummaryThe Baldwin Group is an award-winning entrepreneur-led insurance brokerage firm delivering expertly crafted risk management and insurance solutions to clients across the U.S. and abroad.Key ResponsibilitiesManage client service calendars, including new client onboarding, plan setup, and renewal processing.Prepare client data for marketing efforts,...


  • Houston, United States McDermott International, Ltd Full time

    Job DescriptionCompany OverviewOur ingenuity fuels daily life. Together, we’ve forged some of the most trusted partnerships across the energy value chain to make what was once just an idea a reality: laying subsea infrastructure thousands of feet below sea level, installing platforms hundreds of miles from shore, using our expertise to design and build...


  • Houston, United States McDermott International, Ltd Full time

    Job DescriptionCompany OverviewOur ingenuity fuels daily life. Together, we’ve forged some of the most trusted partnerships across the energy value chain to make what was once just an idea a reality: laying subsea infrastructure thousands of feet below sea level, installing platforms hundreds of miles from shore, using our expertise to design and build...


  • houston, United States McDermott International, Ltd Full time

    Job DescriptionCompany OverviewOur ingenuity fuels daily life. Together, we’ve forged some of the most trusted partnerships across the energy value chain to make what was once just an idea a reality: laying subsea infrastructure thousands of feet below sea level, installing platforms hundreds of miles from shore, using our expertise to design and build...

  • Risk Manager

    3 weeks ago


    Houston, United States G and H Towing Company Full time

    Job Summary The Risk Manager is responsible for preparing underwriting submissions and presentations for all insurance policies, assisting with the placement of certain insurance, and will be responsible for overseeing claims reporting. The Risk Manager will also be responsible for the review of changes to the insurance clause in vendor and other contracts...


  • Houston, United States Katalyst Data Management Full time

    Job DescriptionJob DescriptionAt Katalyst Data Management, we are dedicated to delivering innovative solutions that drive success for our clients. Our commitment to excellence and continuous improvement has established us as a leader in the industry. As we expand our consulting services, we are looking to connect with talented individuals who can help us...

  • Manager, Risk

    3 weeks ago


    Houston, United States Memorial Hermann Health System Full time

    At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed...


  • Houston, United States Apache Industrial Services Full time

    Job Description Position Title: Director, Risk Management Position Reports To: General Counsel & Chief Compliance Officer Position Summary Responsible for the development and management of the company’s risk and claims handling approach. Communicates risk policies and processes for the organization and provides hands-on development of the risk...


  • Houston, United States Harnham Full time

    Houston, TexasOverview: The ideal candidate for this role will need to have a strong background in risk analytics and risk modeling. You will leverage your strong collaboration skills and ability to extract valuable insights from highly complex data sets to ask the right questions and find the right answers. Our client is seeking a Data Scientist with at...


  • houston, United States Harnham Full time

    Houston, TexasOverview: The ideal candidate for this role will need to have a strong background in risk analytics and risk modeling. You will leverage your strong collaboration skills and ability to extract valuable insights from highly complex data sets to ask the right questions and find the right answers. Our client is seeking a Data Scientist with at...


  • Houston, United States Harnham Full time

    Houston, TexasOverview: The ideal candidate for this role will need to have a strong background in risk analytics and risk modeling. You will leverage your strong collaboration skills and ability to extract valuable insights from highly complex data sets to ask the right questions and find the right answers. Our client is seeking a Data Scientist with at...


  • Houston, United States Baldwin Risk Partners Full time

    The Baldwin Group is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses...

  • Risk Management Lead

    4 weeks ago


    Houston, Texas, United States Citigroup Inc Full time

    As a key member of Citigroup Inc's Risk Management team, the Business Risk and Control Professional will be responsible for managing and mitigating operational and compliance risks across various business units. This role requires a strong understanding of risk management principles, as well as excellent communication and leadership skills.Key...


  • Houston, United States Baldwin Risk Partners Full time

    The Baldwin Group is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses...


  • Houston, Texas, United States Capco, a Wipro Company Full time

    About the Role:The Risk Management Consultant will cover Risk Management & Risk Compliance applications and reports. This position will help to grow the trading business and focuses on supporting the Risk Operations business with their efforts to fulfill requirements. Understanding consulting methodologies within the financial services or Energy industry is...


  • Houston, Texas, United States Baldwin Risk Partners Full time

    The Baldwin Group is a leading insurance brokerage firm delivering expertly crafted risk management solutions to clients across the U.S. and abroad. Our award-winning industry expertise, colleagues, and insurers enable us to provide tailored approaches to insurance and risk management.Key Responsibilities:Presents proposals in a professional manner,...


  • Houston, Texas, United States BioUrja Trading Full time

    Job Title: Risk Management SpecialistCompany: BioUrja TradingJob Summary:We are seeking a highly skilled Risk Management Specialist to join our team at BioUrja Trading. As a Risk Management Specialist, you will be responsible for analyzing and managing the company's risk exposure in the commodities market.Key Responsibilities:Risk Analysis: Conduct thorough...


  • Houston, Texas, United States The City of Houston Full time

    Job Summary:The City of Houston is seeking a highly skilled and experienced Risk Management Director to oversee the day-to-day operations of the Occupational Health and Safety Program and the Workers' Compensation Program.Key Responsibilities:Coordinate the development and implementation of relevant policies and procedures in line with up-to-date...