[Hiring] Senior Manager Health Business Analytics, Medicare Risk Adjustment @Florida Blue

Role Description

Manages a team through providing oversight, strategy implementation and execution for Medicare Risk Adjustment Programs. This role plays a pivotal role in managing and optimizing Medicare Advantage (MA) risk adjustment programs. This position will lead the design, planning, measurement, predictive analytic modeling and facilitate an evidenced based approach to drive decisions that enable the growth objectives of the business by leveraging data to enhance revenue accuracy, improve provider documentation, and ensure regulatory compliance.

• Oversee the end-to-end strategy for risk adjustment programs, including prospective and retrospective processes.
• Manage provider workflows, chart reviews, and coding validation to ensure accurate documentation under CMS-HCC models.
• Partner with actuarial and finance teams to support bid development, producing defensible risk score projections, trend analysis, and revenue assumptions.
• Communicate results to executive leadership.
• Manage work to produce customer value by planning and forecasting, setting objectives and priorities, establishing goals, clarifying accountabilities, assigning work and utilizing management and financial controls.
• Lead analysis, provide recommendations, and represent Analytics.
• Work closely with leaders across business areas to drive results across the business.
• Manage levels of performance and assist with employees’ professional growth.
• Communicate effectively; coordinate with others; maintain employee morale; motivate, recognize and reward others; coach and develop others; engage in self-development.
• Manage business and public relationships to obtain better business outcomes.
• Develop, prioritize and implement strategy; set policies and procedures and manage creativity and innovation with primary goal of impacting health business.

Qualifications

• 8+ years related work experience with strong Risk Adjustment experience in commercial and/or Medicare.
• 3+ years direct supervisory/management experience.
• Related Bachelor’s degree or additional related equivalent work experience.
• Experience working with statistical methodologies and risk adjustment.
• Experience writing SQL/SAS or related code to perform quantitative risk score analysis.
• Advanced Excel skills.
• Experience using algorithms and inferential statistics.
• Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills.
• In-depth business process knowledge of several key business functional areas.
• Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences.
• Demonstrated leadership abilities including effective knowledge sharing and conflict resolution.
• Experience communicating and presenting detailed business and financial information.
• Ability to understand overall Analytics strategy and apply/implement the strategy in assigned projects/initiatives/programs.

Preferred Qualifications

• Experience working within the healthcare insurance industry.
• Bachelor’s degree in a related field such as Business Analytics, Health Economics or similar program.
• Master’s degree in a related field.

General Physical Demands

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
• Jobs are sedentary if traversing activities are required only occasionally.

Benefits

• Medical, dental, vision, life and global travel health insurance.
• Income protection benefits: life insurance, short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan including employer match.
• Paid time off, volunteer time off, 10 holidays and 2 well-being days.
• Additional voluntary benefits available.
• A comprehensive wellness program.

Annualized Salary Range

• $119,400 - $194,000.
• Typical Annualized Hiring Range: $119,400 - $149,200.
• Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.