Mgr, Risk Adjustment Vendor & Performance Mgmt

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a leader to manage risk-adjustment vendor strategy, performance measurement, and analytics across Commercial, Medicare, and Medicaid programs.

You will design KPI frameworks, model financial impact, negotiate contracts, and partner with enterprise leaders to drive cost efficiency and quality of care.

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.

Responsibilities

• 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.

Skills

Vendor Management

Risk Adjustment Analytics

KPI Development

Financial Modeling

Contract Negotiation

Data Analytics

Stakeholder Management

Regulatory Awareness

Education

Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field

Tools

SAS

R

SQL

Job description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

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

Job Responsibilities:

• 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
  

What You Bring

Education/Experience :

• 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.

Knowledge:

• 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
  

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$109,600 - $149,625

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.