Risk Adjustment Consultant

5 days ago


Long Beach, California, United States Blue Shield of California Full time
About the Role

We are seeking a highly skilled Risk Adjustment Consulting, Consultant to join our team at Blue Shield of California. As a key member of our Risk Adjustment Prospective Program team, you will play a critical role in transforming healthcare by making it more accessible, affordable, and customer-centric.

Key Responsibilities
  • Lead the Member Incentive Program from inception to completion, driving leadership, guidance, and managing all aspects of the program, including vendor oversight and internal cross-functional partnerships.
  • Manage data analysis, documenting and verifying assumptions used in computations, such as member risk data and score submissions, and establishing revenue accruals.
  • Develop and implement processes for company projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products.
  • Support the In-Home Visit (IHV) program by working with the program lead to address various tasks needed.
  • Collaborate with cross-functional areas to meet objectives, requiring strong interpersonal skills, excellent communication and presentation skills, and the ability to manage projects/timelines to achieve successful outcomes.
Requirements
  • Requires a bachelor's degree; Master's degree preferred.
  • Requires deep knowledge of job area obtained through professional experience and advanced education.
  • Requires at least 6 years of professional experience with 3 years in project management or vendor management experience.
  • Requires proficiency with MS Office (Excel, Word, PowerPoint, and Visio).
  • Risk Adjustment professional experience preferred.
What We Offer

The pay range for this role is: $118,800.00 to $178,200.00 for California. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.



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