Mgr, Risk Adjustment Vendor & Performance Mgmt

About the Role

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.

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

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.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Knowledge:

• Extensive knowledge of risk adjustment and vendor performance management.
• Strong analytical and statistical modeling skills.
• Experience developing KPIs and performance frameworks.
• Advanced Excel proficiency.
• CPA or CMA certification preferred.
• Experience with SAS, R, or SQL preferred.
• Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred.

Skills and Abilities:

• Vendor Management
• Risk Adjustment Analytics
• KPI Development
• Financial Modeling
• Contract Negotiation
• Data Analytics
• Stakeholder Management
• Regulatory Awareness

Benefits

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth