Risk Management Lead, Data & Compliance (Hybrid)

Cambia Health; Medford (OR); Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Paid time off

Job summary

Cambia Health is seeking a Manager of the Risk Management Business Team to lead data submission for CMS Risk Adjustment programs, ensuring accuracy and timeliness. The role collaborates with IT, compliance and enrollment teams and drives process improvements across the risk adjustment lifecycle.

Hybrid work arrangement with in-office presence required three days per week; travel is rare domestically. The team focuses on delivering accurate enrollment, medical and pharmacy claim data to support

Qualifications

• Bachelor's degree in Business, Data Analysis or related field with 10 years of data analysis or process modeling experience.
• Strong analytical skills with ability to translate complex data.
• Experience leading large, complex initiatives and communicating to diverse audiences.

Responsibilities

• Corroborates with IT, compliance, legal and departments to optimize submission measurements.
• Oversees RADV audits and prepares executive reports.
• Develops underwriting rules reflecting rating strategy and revenue targets.
• Directs projects and defines performance criteria and objectives.
• Ensures day-to-day operations are supported by the Risk Management team.

Skills

Analytical skills

Communication

Risk adjustment systems

Project management

Leadership & coaching

AI tools

Education

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

Tools

Edge Server

Job description

Cambia Health is seeking a Manager of the Risk Management Business Team to lead data submission for CMS Risk Adjustment programs, ensuring accuracy and timeliness. The role collaborates with IT, compliance and enrollment teams and drives process improvements across the risk adjustment lifecycle.

Hybrid work arrangement with in-office presence required three days per week; travel is rare domestically. The team focuses on delivering accurate enrollment, medical and pharmacy claim data to support