Mgr, Risk Adjustment Vendor & Performance Mgmt

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

4d•$109,600 - $149,625•Remote

About The Position

This role is responsible for vendor management, performance measurement, and analytics for Enterprise Risk Adjustment. Drives strategy, ensures accurate KPI reporting, and partners cross-functionally to optimize vendor and operational performance across Commercial, Medicare, and Medicaid programs.

Requirements

Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field.
6+ years healthcare or insurance experience with analytics/reporting.
3+ years supervisory experience.
Extensive knowledge of risk adjustment and vendor performance management.
Strong analytical and statistical modeling skills.
Experience developing KPIs and performance frameworks.
Advanced Excel proficiency.
Vendor Management
Risk Adjustment Analytics
KPI Development
Financial Modeling
Contract Negotiation
Data Analytics
Stakeholder Management
Regulatory Awareness

Nice To Haves

CPA or CMA certification preferred.
Experience with SAS, R, or SQL preferred.
Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred.

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
Ensure effective transition and integration of vendor services
Design and maintain KPI frameworks for vendors and internal operations
Develop models and reporting to measure financial impact and operational outcomes
Analyze performance trends and identify improvement opportunities
Audit internal and vendor reporting for accuracy and completeness
Ensure data integrity and adherence to measurement standards
Support compliance and internal control requirements
Monitor vendor spend, billing, and budget performance
Develop forecasts and provide financial insights to leadership
Advise on budget risks and mitigation strategies
Review and reconcile vendor invoices to ensure accurate and timely payment
Partner with enterprise leaders to define targets and corrective actions
Present insights and recommendations to executive stakeholders
Mentor and guide analytics and reporting teams