Medicare Advantage Stars & Risk Performance Leader

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 140,000 - 180,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina seeks a Medicare Advantage Quality and Risk Performance Officer to lead Stars initiatives, improve RAF scores, and ensure audit readiness. You will translate data insights into strategic plans and collaborate with executives to drive performance.

Required: Bachelor's degree; 10 years in insurance or healthcare; 5 years in health plan leadership; Medicare Advantage Stars and risk adjustment experience; strong communication and cross-functional leadership.

Qualifications

• Ability to lead organization-wide initiatives and drive large programs.
• Strong communication and interpersonal skills for executive audiences.
• Experience managing cross-functional teams and vendors.

Responsibilities

• Develop and implement Stars improvement plans for Medicare Advantage programs.
• Monitor performance, track trends, and report progress to leadership.
• Lead risk adjustment initiatives and RAF score optimization.
• Collaborate with providers, vendors, and internal teams to drive results.
• Ensure audit readiness (e.g., RADV) and compliance with CMS requirements.
• Communicate findings and action plans to executives and stakeholders.

Skills

Organizational leadership

Strategic planning

Executive communication

Cross-functional collaboration

Vendor management

Stakeholder management

Education

Bachelor's degree

Master's degree or RN (preferred)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina seeks a Medicare Advantage Quality and Risk Performance Officer to lead Stars initiatives, improve RAF scores, and ensure audit readiness. You will translate data insights into strategic plans and collaborate with executives to drive performance.

Required: Bachelor's degree; 10 years in insurance or healthcare; 5 years in health plan leadership; Medicare Advantage Stars and risk adjustment experience; strong communication and cross-functional leadership.