Mgr, Risk Adjustment Operations

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

This position will lead the coordination of analytics and process functions within the Enterprise Risk Adjustment department and will work with functional leaders to gather input and improve processes in order to achieve organizational objectives. The Risk Adjustment Operations Manager will provide reporting and business insights, generating presentation materials for external groups, and support ad-hoc or special projects. This role will work with divisional and business unit leaders across the enterprise to facilitate and manage risk adjustment alignment activities for those departments.

What You'll Do

• Gather and organize status of operational activities across the risk adjustment department.
• Participate in or lead internal or external project workgroup(s) and presentations.
• Provider regular reporting on the status of operations and analytics functions and provide actionable insight to department and enterprise leadership.
• Author presentation materials including necessary research for external and leadership audiences for department leadership.
• Request analytics and reporting to support decision making related to alignment of Horizon business units to risk adjustment.
• Meet with business unit and divisional leaders across Horizon to define the problem or opportunity, collaborate on solution design, and manage the implementation of alignment solutions related to product development, network design, and pricing practices.
• Present various risk adjustment materials or status to Horizon leadership.
• Escalate issues or other departmental problems and track them to resolution.
• Support management through ad hoc reporting and special projects.
• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

What You Bring

Education/Experience:

• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of six (6) years’ experience with at least four (4) years’ experience in a project support or analysis role.
• Requires people management experience.

Knowledge:

• Detailed knowledge of risk adjustment and health plan operations.
• Knowledge of project management methodologies.
• Knowledge of the creation and management of insurance products, network contracting and design, healthcare management programs, actuarial pricing practices, and analytics functions and techniques.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$97,800 - $133,455

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

About Us

We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too.

Our Mission
We empower our members to achieve their best health.

Our Vision
We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.