Risk Adjustment Operations Manager

6 days ago

Honolulu, Hawaii, United States Hawaii Medical Service Association Full time
Job Summary

Hybrid Work Environment

Compensation Range: $78,000 - $153,000, position eligible for an incentive bonus

Job Description:

The Medicare Risk Adjustment Program Manager has organization-wide responsibilities for the administration of all provisions/requirements of HMSA's Medicare Risk Adjustment program. They are responsible for managing the development and implementation of successful activities that improve the accuracy of the CMS risk adjustment scores of the Medicare Advantage membership.

Key Responsibilities:

  1. Leadership and Performance Management
  • Develops short-term and long-term strategies to meet risk adjustment accuracy goals and requirements.
  • Works internally, and with BCBSA, providers, and vendors to review programs, processes, and data collection for improvement opportunities.
  • Manages the production of performance dashboards to monitor and report ongoing performance against targets. Adjusts as needed to ensure goals are met.
  • Ensures processes and documentation supports risk adjustment program requirements.
  • Supports internal and external teams as a subject matter expert of Medicare Advantage Risk Adjustment.
  • Manages necessary changes to existing systems, operations or workflows to address new/revised requirements of CMS/DHS/MQD.
  • Structures work plans and project scope to deliver business impact on high priority issues.
  • Addresses any identified deficiencies in current program quality and administration.
  • Directs regular organization-wide training to develop staff in other key departments as risk adjustment subject matter experts in context of department work.
  • Meets as needed with the Vice President and Director to review progress, report key results and program performance measures and to reestablish priorities.
  • Conducts regulatory analyses and facilitates requirement development, and implementation tracking.
  • Contributes to the development of business strategies for the Medicare line of business.
Effective Management of Staff
  • Oversees and manages workflows to ensure that services and requests are handled consistently, effectively, and efficiently in order to minimize risks to members and the organization. Documents workflows and work processes.
  • Manages risk adjustment team members and vendors in order to achieve program and project goals. Adjusts roles and responsibilities as needs change.
  • Responsible for ensuring that Medicare Programs contract is meeting risk adjustment requirements established by CMS.
  • Performs various employee management functions including but not limited to; talent management, development, performance reviews, and handles any related adjustments to salary or job description.
Cross-Functional Integration and Communication
  • Acts as the leader and champion of risk adjustment interventions.
  • Develops strong partnerships with key areas throughout the organization and external partners to continually improve risk adjustment accuracy performance.
  • Provides education and information to the entire HMSA community regarding Medicare Advantage risk adjustment. Communicates performance results to all levels of staff including executive management as needed.
Other Duties/Functions
  • Performs all other miscellaneous responsibilities and duties as assigned or directed.

  • Claims Adjuster Trainee

    6 days ago

    Honolulu, Hawaii, United States Pillfast24 Full time

    Job SummaryPillfast24 is seeking a highly motivated and detail-oriented Claims Adjuster Trainee to join our team. As a Claims Adjuster Trainee, you will learn the skills and knowledge necessary to help customers navigate the claims process and resolve disputes efficiently.Key ResponsibilitiesDetermine coverage and liability for claimsInterview customers,...

  • Risk Management Supervisor

    2 weeks ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Job Overview Under the guidance of the Manager, this role is pivotal in steering and enhancing the business unit's risk and compliance frameworks. The position is tasked with overseeing risk assessment methodologies, conducting reviews for new products and services, and managing operational risk governance and reporting initiatives. This leader will also...

  • Risk Management Specialist

    2 weeks ago

    Honolulu, Hawaii, United States Booz Allen Hamilton Full time

    Job SummaryWe are seeking a highly skilled Risk Management Specialist to join our team at Booz Allen Hamilton. As a Risk Management Specialist, you will be responsible for managing the application of analytical risk management principles to prepare for, prevent, mitigate, and respond to risks.Key ResponsibilitiesDevelop and Maintain Risk Management...

  • Military Operations Risk Analyst

    2 weeks ago

    Honolulu, Hawaii, United States Huntington Ingalls Industries Full time

    Position OverviewThe role of the Identity / Risk Management Analyst involves providing critical support in military operations, specifically focusing on Identity Management (IdM) activities. This position requires a professional with a strong background in military analysis and risk management.Key ResponsibilitiesThe selected candidate will:Conduct...

  • Strategic Risk Management Specialist

    4 days ago

    Honolulu, Hawaii, United States Booz Allen Hamilton Full time

    Job SummaryWe are seeking a highly skilled Strategic Risk Management Specialist to join our team at Booz Allen Hamilton. As a key member of our organization, you will be responsible for developing and maintaining the Program Risk Framework, Risk Management Plan, and Standard Operations Procedures (SOPs) to document processes, activities, instructions, best...

  • Military Operations Risk Analyst

    2 weeks ago

    Honolulu, Hawaii, United States Huntington Ingalls Industries Full time

    Position OverviewThe Identity / Risk Management Analyst (Military Operations Analyst 3) is a critical role focused on providing comprehensive operational support in the realm of Identity Management (IdM). This position is designed for individuals with a strong background in military operations or intelligence community functions.Key Responsibilities:Conduct...

  • Military Operations Risk Analyst

    2 weeks ago

    Honolulu, Hawaii, United States Huntington Ingalls Industries Full time

    Position OverviewThe Identity / Risk Management Analyst plays a crucial role in supporting military operations by conducting comprehensive assessments and evaluations related to Identity Management (IdM) initiatives.Requisition Number: 19709Employment Type: Full Time/Salaried/ExemptAnticipated Salary Range: $78,000 - $120,000Security Clearance: TS/SCI with...

  • Director of Cybersecurity and Risk Management

    3 days ago

    Honolulu, Hawaii, United States Highmark Health Full time

    Job SummaryWe are seeking a highly experienced and skilled Director of Cybersecurity and Risk Management to join our team at Highmark Health. As a key member of our Information Security and Risk Management department, you will be responsible for directing and managing our cybersecurity and risk management services to ensure the confidentiality, integrity,...

  • Technology Risk Management Specialist

    4 days ago

    Honolulu, Hawaii, United States Bank of Hawaii, Inc. Full time

    Job SummaryAs a Technology Risk Management Specialist at Bank of Hawaii, Inc., you will play a critical role in ensuring the bank's technology infrastructure is secure and resilient. This position is responsible for developing and maintaining an effective Technology Risk Management program to identify, assess, mitigate, manage, monitor, and report technology...

  • Technology Risk

    1 month ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Job DescriptionUnder the direction of the Manager, responsible for independent risk management activities over the Bank of Hawaii technology footprint covering core technology infrastructure, information security, and enterprise resilience as part of the second line of defense Risk organization. This position develops and maintains an effective Technology...

  • Senior Cyber Security Risk Management Leader

    2 weeks ago

    Honolulu, Hawaii, United States HMSA Full time

    Position OverviewThe Senior Cyber Security Risk Management Leader is responsible for overseeing and directing the comprehensive IT Risk Management program at HMSA. This role is pivotal in ensuring the organization adheres to best practices and industry standards in cyber security risk management.Key ResponsibilitiesCyber Security Risk Management: Lead and...

  • Cyber Security Risk Management Senior Manager

    2 weeks ago

    Honolulu, Hawaii, United States HMSA Full time

    Cyber Security Risk Management:Oversee and direct HMSA's IT Risk Management initiative by utilizing established best practices and frameworks within the industry.Develop strategic roadmaps that align with the Chief Information Security Officer's vision.Ensure the Risk Register is consistently updated and effectively communicated across relevant stakeholders....

  • Enterprise Risk Management Director

    2 days ago

    Honolulu, Hawaii, United States Bank of Hawaii, Inc. Full time

    Job SummaryAs a key member of the Bank of Hawaii, Inc. team, the Enterprise Risk Management Director will play a critical role in overseeing and implementing the Bank's Enterprise Risk Management (ERM) Program. This position will ensure that business units comply with applicable laws, regulations, and regulatory requirements, including those related to:Key...

  • Senior Manager of Cyber Security and Risk

    6 days ago

    Honolulu, Hawaii, United States HMSA Full time

    About the RoleWe are seeking a highly skilled and experienced Senior Manager of Cyber Security and Risk to join our team at HMSA. As a key member of our organization, you will be responsible for leading our Cyber Security Risk Management program and ensuring the effective management of cyber risks across the organization.Key ResponsibilitiesCyber Security...

  • Cyber Security Risk Management Leader

    6 days ago

    Honolulu, Hawaii, United States HMSA Full time

    About the RoleWe are seeking a highly skilled and experienced Senior Manager of Cyber Security and Risk to lead our Cyber Security Risk Management program at HMSA. This is a critical role that requires a strong understanding of IT risk management best practices, industry frameworks, and Enterprise NIST CSF.Key ResponsibilitiesCyber Security Risk...

  • Senior Compliance and Risk Management Specialist

    2 weeks ago

    Honolulu, Hawaii, United States Centerwell Full time

    Join Our Team at CenterwellAs a vital member of our dedicated community, you will play a crucial role in prioritizing health and safety. Position OverviewThe Senior Compliance and Risk Management Specialist is responsible for identifying and evaluating potential risks to mitigate losses effectively. This role involves addressing moderately complex to...

  • Fraud Risk Analyst

    2 weeks ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Become a Key Player as a Fraud Risk Analyst at Bank of HawaiiConducts thorough investigations of all assigned alerts pertaining to fraud risk and behavioral analysis. Monitors, reviews, and tracks the outcomes of alerts, managing technically intricate accounts associated with high-risk fraud activities.Contributes to the formulation of departmental...

  • Fraud Risk Analyst

    1 week ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Become a Key Player as a Fraud Risk Analyst at Bank of HawaiiConducts thorough investigations of all assigned alerts concerning fraud risk assessment and behavioral analysis. Monitors, reviews, and tracks the outcomes of alerts, managing technically intricate accounts that involve high-risk fraud scenarios.Contributes to the formulation of departmental...

  • Fraud Risk Analyst

    1 week ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Become a Key Player as a Fraud Risk Analyst at Bank of HawaiiConducts thorough investigations of all assigned alerts concerning fraud risk assessment and behavioral analysis. Monitors, reviews, and tracks the outcomes of alerts while managing technically intricate accounts that involve high-risk fraud scenarios.Contributes to the formulation of departmental...

  • Fraud Risk Analyst

    1 week ago

    Honolulu, Hawaii, United States Bank of Hawaii Full time

    Become a Part of Our Team as a Fraud Risk Analyst at Bank of HawaiiConducts thorough investigations of all assigned alerts pertaining to fraud risk assessment and behavioral analysis. Monitors, reviews, and tracks the outcomes of alerts, managing technically intricate accounts that involve high-risk fraudulent activities.Contributes to the development of...