[Hiring] Manager, Risk Adjustment Vendor & Performance Management @Horizon Blue Cross Blue Shield of New Jersey

Role Description

This role is responsible for vendor management, performance measurement, and analytics for Enterprise Risk Adjustment. Drives strategy, ensures accurate KPI reporting, and partners cross-functionally to optimize vendor and operational performance across Commercial, Medicare, and Medicaid programs.

What You'll Do

• Develop and lead risk adjustment vendor strategy aligned to enterprise goals
• Identify vendor needs, source and evaluate partners, and define success measures
• Negotiate contracts and own day-to-day vendor relationships
• Lead RFPs, vendor selection, implementation, and offboarding
• Manage onboarding and wind-down activities including data retention and destruction
• Ensure effective transition and integration of vendor services
• Design and maintain KPI frameworks for vendors and internal operations
• Develop models and reporting to measure financial impact and operational outcomes
• Analyze performance trends and identify improvement opportunities
• Audit internal and vendor reporting for accuracy and completeness
• Ensure data integrity and adherence to measurement standards
• Support compliance and internal control requirements
• Monitor vendor spend, billing, and budget performance
• Develop forecasts and provide financial insights to leadership
• Advise on budget risks and mitigation strategies
• Review and reconcile vendor invoices to ensure accurate and timely payment
• Partner with enterprise leaders to define targets and corrective actions
• Present insights and recommendations to executive stakeholders
• Mentor and guide analytics and reporting teams

Qualifications

• Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field
• 6+ years healthcare or insurance experience with analytics/reporting
• 3+ years supervisory experience

Requirements

• Extensive knowledge of risk adjustment and vendor performance management
• Strong analytical and statistical modeling skills
• Experience developing KPIs and performance frameworks
• Advanced Excel proficiency
• CPA or CMA certification preferred
• Experience with SAS, R, or SQL preferred
• Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred

Skills and Abilities

• Vendor Management
• Risk Adjustment Analytics
• KPI Development
• Financial Modeling
• Contract Negotiation
• Data Analytics
• Stakeholder Management
• Regulatory Awareness

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Salary Range

$109,600 - $149,625