Manager, Risk Adjustment Operations

Capital Blue Cross

Manager overseeing Risk Adjustment Operations for Medicare Advantage and ACA. Ensuring program performance and leading cross-functional collaboration for operational initiatives.

Posted 7/30/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $83,800 - $157,890 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing Medicare Advantage and ACA Risk Adjustment initiatives, with a strong focus on operational execution, performance monitoring, and cross-functional collaboration. Proficient in developing project plans and utilizing analytical skills to identify and mitigate operational barriers.

Highest-signal resume keywords

Operations ManagementRisk Adjustment OperationsCross-Functional LeadershipAnalytical SkillsLean Six Sigma Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Project ManagementOperational MetricsKPI MonitoringVendor ManagementAdvanced Excel Skills

Soft Skills

Problem-SolvingAccountabilityCollaboration

Tools & Technologies

Microsoft Office

Certifications & Qualifications

Lean Six Sigma

Industry Keywords

Medicare AdvantageACAHealthcare AdministrationPublic HealthHealth Information Management

About the role

Key responsibilities & impact

Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives
Develop and maintain integrated project plans, operational calendars, risk logs, and status reporting
Monitor program performance through dashboards, KPIs, and operational metrics
Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, and others
Hold internal teams and external vendors accountable for operational performance
Proactively identify operational barriers and develop mitigation plans
Lead operational vendor onboarding and offboarding activities

Requirements

What you’ll need

5 years of Operations and/or Program management
3 years of Risk Adjustment Operations or Program Management
Experience leading complex, cross-functional operational initiatives
Experience supporting vendor selection and evaluations
Strong analytical and problem-solving skills
Proficiency with Microsoft Office applications, including advanced Excel skills
Bachelor’s degree in business administration, Healthcare Administration, Public Health, Health Information Management, Finance, Economics or 9 years relevant and progressive experience in lieu of bachelor's degree
Lean Six Sigma or other operational excellence/process improvement certification preferred

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off, Holidays, and Volunteer time off
Incentive Plan
Tuition Reimbursement