Mgr Risk Management Business Team

Cambia Health Solutions; Boise (ID); Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

10 company-paid holidays

Generous retirement plan with match

Remote-friendly work options

Job summary

Cambia Health Solutions in Boise, ID, is seeking a Manager for the Risk Adjustment Business Team. The hybrid role requires three days in the office and focuses on CMS enrollment, medical and pharmacy claim data accuracy and timely submissions to Edge Server.

You will collaborate with IT, compliance and actuarial partners, develop underwriting rules aligned to revenue targets, oversee audits, and drive process improvements while mentoring staff and building a high-performing team.

Qualifications

• Bachelor's degree in Business, Data Analysis or related field.
• 10+ years' experience in data analysis, process modeling or equivalent.
• Experience leading risk management or data submission initiatives.

Responsibilities

• Oversee data submission to CMS Edge Server and ensure accuracy.
• Collaborate with IT, compliance, legal and business teams on risk programs.
• Develop underwriting rules reflecting rating strategy and revenue targets.
• Lead large, complex initiatives and drive project outcomes.
• Mentor staff, manage performance and foster team development.
• Maintain and improve departmental policies and procedures.
• Manage audit processes and ensure training materials are current.
• Communicate departmental goals and progress to leadership.

Skills

Analytical skills

Communication skills

Risk adjustment knowledge

Project leadership

Team development

AI tools familiarity

Education

Bachelor's degree in Business or Data Analysis

Job description

Manager - Risk Adjustment Business Team

Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston offices. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate.

Who We Are Looking For:

Every day, Cambia's dedicated Risk Management Business Team Manager is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Management Business Team Manager is responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claim data for Reinsurance and Risk Adjustment programs. Leads a team dedicated to extracting required information from the source systems into a staging area, performing validation checks based on CMS Edge Server Business Rules, and submitting correct data to the Edge Server via a translation process. - all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

The Manager, Risk Management Business Team would have a Bachelor's degree in Business, Data Analysis or other related field and 10 years' experience with data analysis, process modeling or equivalent combination of education and experience.

Skills and Attributes:

• Strong analytical skills including the ability to analyze complex data and situations, learn quickly and synthesize corresponding solutions, options and action plans.
• Ability to understand, translate and communicate complex ideas and situations to a wide variety of audiences.
• Excellent research and problem solving skills including the ability to determine action steps and remediation actions to resolve issues.
• Strong knowledge of risk adjustment systems and processes.
• Demonstrated experience in business areas, working with business requirements, documentation and data systems.
• Strong knowledge of project management processes and practices including experience leading large, complex initiatives.
• Knowledge of medical terminology and procedure coding.
• Ability to communicate effectively verbally and in writing with all levels of staff.
• Ability to develop and lead a team including: hiring, goal setting, motivating, coaching and staff development.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Corroborates closely with the IT, compliance, legal, revenue management, claims, enrollment, product teams and other departments to maximize and maintain submission measurements
• Helps oversee RADV audits, submits data in a timely manner and prepares executive reports.
• Develops medical underwriting rules for the Risk Management business system which accurately reflect the rating strategy and drive achievement of company revenue targets.
• Directs business projects and is responsible for the development and delivery of project performance criteria and objectives.
• Ensures day-to-day operations are appropriately supported by the Risk Management business team, identifying issues and recommending solutions.
• Develops and reviews business policies, processes and practices to ensure seamless coordination with the Risk Management business team.
• Develops, implements and monitors audit processes to ensure accurate utilization of the Edge Server system by assigned users. Responsible for training materials and delivery.
• Regularly interacts with the IT team, identifying issues and partnering on resolutions to ensure the data submission system is functioning accurately.
• Responsible for staff development, performance conversations, performance coaching and retention activities. Regularly communicates departmental and organizational goals and objectives to staff.
• Develops and maintains departmental policies and procedures and assures adherence to departmental standards and practices.
• Oversees the data submission system and ensures it is functioning accurately.

Work Environment

• Work performed in the office or remote.
• Travel rarely required, locally, or out of State.

Oregon, Washington, Utah, and Idaho:The expected hiring range is$111,400.00 - $150,700.00, the full salary range is$104,000.00 - $171,000.00and the bonus target is17%

North Dakota:The full salary range is101,444 - 167,383 and the bonus target is15%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.