Risk Management Lead – Data & Compliance

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

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.