Risk Adjustment Program Consultant

Health Care Service   •  

Chicago, IL

5 - 7 years

Posted 247 days ago

This job is no longer available.


This position is responsible for regulatory management and leadership of complex and evolving regulatory activities to support Actuarial operational needs and deliverables; serves as subject matter expert in cross functional teams;

Facilitate and participate in evaluation, development and implementation of new or modified strategies, processes, and operational methods and solutions in relation to business objectives, decisions and statutes, regulations and/or sub-regulatory guidance requirements.


* Bachelor degree and 5 years of experience in business; or 9 years’ experience in related field.
* 3 years of regulatory experience.
* Experience providing support to senior staff in process re-engineering and strategic problem-solving.
* Experience conducting analyses and developing, executing and communicating strategic and operational impacts.
* Creative thinking skills.
* Experience providing strategic and tactical direction based on quantitative and qualitative analyses.
* Knowledge of the regulatory process and health care industry business requirements, processes, functions and drivers.
* Experience communicating and providing support to senior level staff in process re-engineering and strategic problem-solving.
* Knowledge of enterprise business operations.
* Experience managing multiple projects and project teams.
* Effective skills in both verbal and written communication, including facilitation and presentations.
* Effective interpersonal skills.
* Strong organizational skills and detail oriented.
* Problem resolution experience and skills dealing with internal and external customer needs.
* Handle and manage multiple tasks and projects simultaneously.
* Experience working independently and responding to rapidly changing priorities to achieve goals and objectives in a timely manner.
* Skills to operate in cross-functional teams.
* PC proficiency to include Microsoft Word, Excel and PowerPoint.


* Working knowledge of business process model and organizational functions.
* Working knowledge of the Affordable Care Act and Reinsurance and Commercial and Medicare Risk Adjustment programs.
* Understand impact of CMS Risk Adjustment RAPS, EDPS and EDGE server submissions
* Strong Data Management Skills
* Intermediate knowledge of Excel ad Access Databases
* Ability to manage multiple data sources, provider groups and vendors
* Ability to coordinate between multiple internal and external business partners.

Job ID: DLP-1024964