AdvantmedHiring

Senior Risk Adjustment Solutions Analyst

  • Remote, United States
  • Senior
  • Posted 2 weeks ago
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In one line

Senior analyst role on a data analytics team, focused on Medicare Advantage and ACA risk adjustment, turning claims and CMS data into insights for health plan clients.

About the role

Own risk adjustment analytics and strategy, from RAF opportunity analysis to CMS data reporting, and act as the subject matter expert for clients and internal teams.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Senior
Skills
SQL, CMS-HCC, RxHCC, Medicare Advantage, ACA Risk Adjustment, HEDIS, MMR, MOR
Posted
7 Oct 2026
Last checked
19 Oct 2026

What you will do

  • Analyze Medicare Advantage and ACA risk adjustment performance to find RAF and revenue opportunities
  • Work with CMS-HCC and RxHCC models and advise on Medicare risk adjustment methods
  • Clean, reconcile and validate large datasets covering claims, encounters, eligibility, pharmacy and medical records
  • Write and tune complex SQL queries, stored procedures and extraction processes
  • Build scorecards, dashboards and ad hoc reports, and explain findings to clients and executives

What they look for

  • At least five years in healthcare data analytics, including mining, mapping, validation and reporting
  • Three or more years working hands-on with Medicare Advantage or ACA risk adjustment
  • Three or more years as a healthcare data analyst with advanced SQL development

Nice to have

  • Familiarity with HEDIS and healthcare quality measures

How Keywordise applies for you

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Claude

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Connector URL
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Muse

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Message for Muse
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Muse is available in the US only for now.

Prompt
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Questions about this job

Can I do this job remotely, and from which countries?

Yes, it is listed as remote, aimed at candidates in the United States.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a senior role. The posting asks for: at least five years in healthcare data analytics, including mining, mapping, validation and reporting; three or more years working hands-on with Medicare Advantage or ACA risk adjustment; three or more years as a healthcare data analyst with advanced SQL development. Skills it names include SQL, CMS-HCC, RxHCC, Medicare Advantage.

How do I apply with Keywordise AI?

Click Apply with Keywordise AI, create an account and upload your CV. Your CV and cover letter are written for this job from what you have really done, then Keywordise applies for you. Trial: 7 days, no card.

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