Senior Risk Management Lead – Data & Compliance

Cambia Health; Fargo (ND); Hybrid; USD 101,000 - 167,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plan with company match

Generous paid time off

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking a Manager, Risk Management Business Team to lead a team responsible for CMS data submission for enrollment, medical, and pharmacy claims. The role spans multiple offices, with a hybrid work model (3 days in office).

You will drive risk adjustment initiatives, collaborate with IT and compliance, and oversee audits and reporting to support revenue targets. The ideal candidate will have a strong background in data analysis, leadership, and risk-adjustment systems,

Qualifications

• Bachelor's degree in Business, Data Analysis or related field.
• 10 years' experience with data analysis, process modeling or equivalent combination of education and experience.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management, enrollment, product teams to maximize submission measurements.
• Oversees RADV audits, submits data timely and prepares executive reports.
• Develops medical underwriting rules reflecting rating strategy and revenue targets.
• Directs projects and delivers performance criteria and objectives.
• Ensures day-to-day operations are supported by the Risk Management team.
• Develops policies and procedures and ensures adherence to standards.
• Monitors audit processes to ensure data submission system accuracy.
• Delivers staff training materials and coordinates with IT for issue resolution.

Skills

Analytical thinking

Leadership

Project management

Data analysis

Communication

Risk adjustment knowledge

AI tools

Education

Bachelor's degree

Tools

Edge Server

CMS Rules

Job description

Cambia Health Solutions is seeking a Manager, Risk Management Business Team to lead a team responsible for CMS data submission for enrollment, medical, and pharmacy claims. The role spans multiple offices, with a hybrid work model (3 days in office).

You will drive risk adjustment initiatives, collaborate with IT and compliance, and oversee audits and reporting to support revenue targets. The ideal candidate will have a strong background in data analysis, leadership, and risk-adjustment systems,