19 days old

Director Government Markets Risk Adjustment & Analytics

Independence Blue Cross LLC
Philadelphia, PA 19107
  • Job Code

Bring your drive for excellence, team orientation and customer commitment to Independence; help us renew and reimagine our business and shape the future of health care.Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team. If this describes you, we want to speak with you.

The Director Government Markets Risk Adjustment and Analytics reports to the VP Government Markets Performance. This position will be responsible for directing the strategy, development and reporting of Government Markets (GM) revenue levers around Risk Adjustment. Risk adjustment analytics for both the Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business, membership reporting and forecasting in support of sales, and strategic analysis supporting Government Markets strategic priorities.


  • The Director oversees a team responsible for the following:
  • Risk adjustment programs for Medicare and Affordable Care Act (ACA) business.

  • Evaluation of Medicare Advantage and ACA Risk Adjustment accuracy improvement strategy. Includes constantly identifying initiatives that yield improvement and/or optimization.

  • Monitoring, forecasting and reporting risk scores and risk adjustment revenue throughout the year working in collaboration with Actuarial Department.

  • Calculated valuation of revenue levers and assess financial impact.

  • Collaboration with actuarial to provide risk adjustment inputs into bid pricing and financial statements.

  • Collaboration with appropriate business areas to understand trends driving member and provider behavior.

  • Reporting and forecasting on membership enrollment, sales, and channel.
  • Collaborates with leadership in Business Technology Services (BTS), Informatics and Facilitated Health Networks to build and maintain effective relationships to meet the goals and objectives of Government Markets specifically, help commission, specify, and apply technology capabilities to core MA and ACA activities.

  • Collaborates with other functions to assess various strategic options for MA and ACA to achieve strategic goals.


    • BA/BS in Business, Healthcare Administration, Finance, Economics or related field. MBA/MS/MA preferred.

    • Ten (10) or more years of progressively more responsible experience with Government Programs including Medicare Advantage Risk Adjustment or ACA risk adjustment.

    • Excellent knowledge of Medicare Advantage marketplace and understanding of CMS initiatives and reasoning and/or ACA marketplace and policy

    • Related strategic operations experience and development in the health care & insurance business segment.

    • Strong knowledge and experience in compliance with CMS regulatory guidance.

    • Strong communication skills to interact with stakeholders both inside and outside the company.

    • Excellent analytical, interpersonal and presentation skills.

    • Expert level knowledge of SQL Server, SSIS, SSRS

    • Expert level knowledge of MS Access, Excel, PowerPoint and MS Project

    • Strong knowledge of Tableau data visualization software

    • Knowledge of statistical software (R or SAS)

    Posted: 2021-01-05 Expires: 2021-02-03
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    Director Government Markets Risk Adjustment & Analytics

    Independence Blue Cross LLC
    Philadelphia, PA 19107

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