Role Summary

HIGHLIGHTS

Director-level health actuarial role focused on Risk Adjustment and Quality Analytics at a Minnesota Blue Cross plan. Lead analytics for Medicare, ACA, and Medicaid risk score computation, forecasting, RADV audit support, and performance measurement. Manage a team, influence pricing/budget decisions, and build dashboards and provider performance reporting. Hybrid role anchored in Eagan, MN (two days in office per week).

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment and Quality Analytics for Medicare, ACA, and Medicaid
Oversee risk score computation, forecasting, and diagnostic coding gap analysis
Manage and grow a cross-functional analytics team with hiring and performance duties
Drive dashboards, provider performance metrics, and audit support (RADV/OIG)
Hybrid role — typically 2 days per week in the Eagan, MN office

DOMAIN EXPERTISE

Medicare/ACA/Medicaid risk adjustment analytics
risk score computation and forecasting
RADV and regulatory audit support
diagnostic coding gap identification and confidence modeling
provider performance and engagement analytics

KEY REQUIREMENTS

7+ years related experience with 3+ years management experience
ASA credential or equivalent experience required
Proficient with statistical software (e.g. SAS) and cloud-based platforms
Experience with risk score computation and forecasting for Medicare/ACA/Medicaid
Legal authorization to work in the U.S. required

TECH STACK

No tech stack specified

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Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment and Quality Analytics for Medicare, ACA, and Medicaid
Oversee risk score computation, forecasting, and diagnostic coding gap analysis
Manage and grow a cross-functional analytics team with hiring and performance duties
Drive dashboards, provider performance metrics, and audit support (RADV/OIG)
Hybrid role — typically 2 days per week in the Eagan, MN office

DOMAIN EXPERTISE

Medicare/ACA/Medicaid risk adjustment analytics
risk score computation and forecasting
RADV and regulatory audit support
diagnostic coding gap identification and confidence modeling
provider performance and engagement analytics

KEY REQUIREMENTS

7+ years related experience with 3+ years management experience
ASA credential or equivalent experience required
Proficient with statistical software (e.g. SAS) and cloud-based platforms
Experience with risk score computation and forecasting for Medicare/ACA/Medicaid
Legal authorization to work in the U.S. required

TECH STACK

No tech stack specified

Role Summary

HIGHLIGHTS

JOB DESCRIPTION SUMMARY

Lead Risk Adjustment and Quality Analytics for Medicare, ACA, and Medicaid
Oversee risk score computation, forecasting, and diagnostic coding gap analysis
Manage and grow a cross-functional analytics team with hiring and performance duties
Drive dashboards, provider performance metrics, and audit support (RADV/OIG)
Hybrid role — typically 2 days per week in the Eagan, MN office

DOMAIN EXPERTISE

Medicare/ACA/Medicaid risk adjustment analytics
risk score computation and forecasting
RADV and regulatory audit support
diagnostic coding gap identification and confidence modeling
provider performance and engagement analytics

KEY REQUIREMENTS

7+ years related experience with 3+ years management experience
ASA credential or equivalent experience required
Proficient with statistical software (e.g. SAS) and cloud-based platforms
Experience with risk score computation and forecasting for Medicare/ACA/Medicaid
Legal authorization to work in the U.S. required