Hybrid Risk Management Team Lead — Data & Compliance

Cambia Health Solutions; Utah; Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Annual HSA contribution

Paid time off

Retirement plan with company match

Parental leave up to 12 weeks

Wellness programs

Employee Assistance Fund

Commuter benefits

Job summary

Cambia Health Solutions is seeking a Manager for the Risk Adjustment Business Team in a hybrid role with office presence. You will lead submission workflows for Enrollment, Medical Claim and Pharmacy Claim data, ensuring compliance with CMS mandates and driving revenue targets through robust risk adjustment processes.

You will oversee audits, develop underwriting rules, and guide a team across multiple departments to optimize data submission and process improvements.

Qualifications

• Bachelor's degree in Business, Data Analysis or related field required.
• 10 years of experience in data analysis, process modeling or equivalent.
• Experience with risk adjustment systems and processes.
• Ability to lead a team, hire, set goals and coach staff.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management, claims, enrollment and product teams to maximize submission measurements.
• Oversees RADV audits and prepares executive reports.
• Develops rules for Risk Management system reflecting rating strategy and revenue targets.
• Directs projects and defines performance criteria and objectives.
• Ensures daily operations are supported and issues are resolved.
• Develops, implements and monitors audit processes for Edge Server system usage; trains users.

Skills

Analytical thinking

Complex communication

Research & problem solving

Risk adjustment knowledge

Project management

Medical terminology & coding

Verbal & written communication

Team leadership & development

Experience with AI tools

Education

Bachelor's degree in Business/Data Analysis or related field

Job description

Cambia Health Solutions is seeking a Manager for the Risk Adjustment Business Team in a hybrid role with office presence. You will lead submission workflows for Enrollment, Medical Claim and Pharmacy Claim data, ensuring compliance with CMS mandates and driving revenue targets through robust risk adjustment processes.

You will oversee audits, develop underwriting rules, and guide a team across multiple departments to optimize data submission and process improvements.