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Job Details

Risk Adjustment Manager

Company name
Blue Shield of California

San Francisco, CA
24 hit(s)  


Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of Californias Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Overall responsibility and accountability for reviewing staff work product related to reserving, CMS/ACA related risk adjustment processes, pricing, forecasting, trend setting, and/or network development and alternative provider payment models.

Responsible for developing and managing experience tracking reports, comparisons to Plan, tracking and quantifying variances and shares insights with the business unit and management

Ensures timely and accurate delivery of all work products associated with their job responsibilities.

Ensures team follows existing work flow procedures or policies and/or validates or developments new procedures and policies.

Responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations.

Bachelor's degree in actuarial science, mathematics, statistics, computer science or related field and 7 years prior relevant job including 3 years experience of operating in a team leader role.

Typically, has at least an Associate of the Society of Actuaries(ASA)

Has advanced knowledge, skills and expertise of job area including technical or functional expertise, business acumen, financial analysis skills, and risk management

Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Company Profile
Blue Shield of California, an independent member of the Blue Shield Association, is a nonprofit health plan dedicated to providing Californians with access to high-quality health care at an affordable price.As a nonprofit health plan, Blue Shield is guided by our mission and values, which encourage innovation and enable us to be a catalyst for constructive change. Our mission and values are embodied in our proposal to guarantee health coverage for all Californians, the first time a major health plan has called for universal coverage. See our 2015 Mission Report.

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