Strategic Lead, Risk Adjustment Vendor Performance

Horizon Blue Cross Blue Shield; Newark (NJ); Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Dental/Vision

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager of Risk Adjustment Vendor & Performance Management to lead vendor strategy and performance analytics for Enterprise Risk Adjustment in Newark, with remote work options. The role drives KPI design, contract governance, and cross-functional collaboration to optimize Medicare, Medicaid, and Commercial risk programs.

Ideal candidates bring 6+ years in healthcare analytics, strong vendor management, and financial modeling skills, plus

Qualifications

• 6+ years healthcare or insurance experience with analytics/reporting.
• 3+ years supervisory experience.
• CPA or CMA certification preferred (if applicable).

Responsibilities

• Develop and lead risk adjustment vendor strategy aligned to enterprise goals.
• Identify vendor needs, source and evaluate partners, and define success measures.
• Negotiate contracts and own day-to-day vendor relationships.
• Lead RFPs, vendor selection, implementation, and offboarding.
• Manage onboarding and wind-down activities including data retention and destruction.
• Design and maintain KPI frameworks for vendors and internal operations.
• Develop models and reporting to measure financial impact and operational outcomes.
• Audit internal and vendor reporting for accuracy and completeness.
• Monitor vendor spend, billing, and budget performance.
• Present insights and recommendations to executive stakeholders.

Skills

Vendor Management

Risk Adjustment Analytics

KPI Development

Financial Modeling

Contract Negotiation

Data Analytics

Stakeholder Management

Regulatory Awareness

Education

Bachelor’s degree preferred

Tools

SAS

R

SQL

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager of Risk Adjustment Vendor & Performance Management to lead vendor strategy and performance analytics for Enterprise Risk Adjustment in Newark, with remote work options. The role drives KPI design, contract governance, and cross-functional collaboration to optimize Medicare, Medicaid, and Commercial risk programs.

Ideal candidates bring 6+ years in healthcare analytics, strong vendor management, and financial modeling skills, plus