Risk Management Team Lead – Data & Compliance

Cambia Health; Saint Paul (MN); Hybrid; USD 104,000 - 171,000; Full time

Benefits offered by this job

Competitive base pay

Generous benefits

401(k) with company match

Bonus opportunities

Job summary

Cambia Health seeks a Manager - Risk Adjustment for the Risk Management Business Team. This hybrid role requires 3 days in the office and involves leading data submission, validation, and CMS-mandated processes across Enrollment, Medical and Pharmacy Claims to support Reinsurance and Risk Adjustment programs.

You will guide a team, oversee audits, and develop rules aligned with revenue targets while collaborating with IT, compliance and product teams. Travel may be rare.

Qualifications

• Bachelor's degree required with 10 years' data analysis or process experience.
• Strong analytical and problem-solvING skills with the ability to translate complex ideas.
• Knowledge of risk adjustment systems and data submission processes.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management and other teams to maximize submission measurements.
• Oversees RADV audits, submits data timely and prepares executive reports.
• Develops underwriting rules reflecting rating strategy to drive revenue targets.
• Directs projects, defines performance criteria and ensures operations run smoothly.
• Mentors staff, conducts performance conversations and supports staff development.

Skills

Analytical skills

Risk adjustment knowledge

Project management

Communication

Team leadership

AI tools familiarity

Education

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

Job description

Cambia Health seeks a Manager - Risk Adjustment for the Risk Management Business Team. This hybrid role requires 3 days in the office and involves leading data submission, validation, and CMS-mandated processes across Enrollment, Medical and Pharmacy Claims to support Reinsurance and Risk Adjustment programs.

You will guide a team, oversee audits, and develop rules aligned with revenue targets while collaborating with IT, compliance and product teams. Travel may be rare.