Risk Adjustment Analyst II

Risk Adjustment Analyst II

  • Location

    Newark, United States

  • Sector:

    Risk Management

  • Job type:


  • Contact:

    Margarita Romero

  • Contact email:


  • Job ref:


  • Published:

    4 months ago

  • Expiry date:


  • Consultant:


JCW is currently working on a search for a Risk Adjustment Analyst with a leading health insurance organization in New Jersey. The qualified candidate will perform analytical studies related to Risk Adjustment as well as the Reinsurance and Risk Corridors.

Responsibilities include:

  • Conduct gap analysis and data collection and validation. Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.
  • Identify and implement improvements to the Edge Server data. Coordinate with IT and other departments involved in running Edge Server as well as all other mandatory aspects of the 3R-s.
  • Coordinate the work on government audit of risk adjustment data (RADV Audit).


  • BA/BS in Mathematics, Statistics, Computer Science, Actuarial Science or other strong analytical field
  • Experience with manipulating large amounts of clinical and medical claims data while working in health care industry, insurance or related field.
  • Expertise with statistical software tools in order to perform data manipulation and analysis
  • 5-7 years with both hands on and oversight experience with predictive analytics in health care industry, insurance or related field; clinical and medical claims data and disease diagnostic coding practice a plus.
  • Computer skills: Excel (including pivot tables), Access (including VBA),
  • Excellent knowledge of SAS and SQL is a must.

Margarita Romero recruits for Risk and Analytics professionals across the financial services sector and would be happy to provide further details about this or other positions. You can reach her at (646) 564 – 3594 or at margarita.romero@jcwresourcing.com.