Designation: Sr. Risk Adjustment Solutions Analyst
Department: Data Analytics
Shift: 2 PM to 11:30 PM IST
Location: Remote - India

Role Summary:
We are seeking a highly motivated and experienced Risk Adjustment Specialist to join our growing Data Analytics team. This role is ideal for healthcare analytics skilled with deep expertise in Medicare Advantage, ACA Risk Adjustment, CMS data, and healthcare analytics.
The successful candidate will serve as a trusted subject matter expert, partnering with clients, operations, technology, and leadership teams to transform complex healthcare data into actionable insights that drive Risk Adjustment performance, improve operational efficiency, and support strategic decision-making.

Required Qualifications:
Education
• Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field.

Experience
• 5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting.
• 3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment.




• 3+ years of experience as a Healthcare Data Analyst.
• 3+ years of advanced SQL development experience.

Healthcare & Risk Adjustment Expertise
Strong understanding of:
• Medicare Advantage and ACA Risk Adjustment programs
• CMS-HCC and RxHCC models
• Medical Record Review (MRR) and Health Assessment processes
• Claims, Encounter, Eligibility, and Pharmacy data
• CMS data files, including MMR and MOR
• End-to-end Risk Adjustment lifecycle
• HEDIS and healthcare quality measures

Technical Skills
• Advanced SQL and Microsoft SQL Server
• SQL Server Management Studio (SSMS)
• Data mapping, reconciliation, and validation
• Root cause analysis and data quality management
• Ad hoc reporting and data extraction

Professional Skills
• Strong analytical and problem-solving abilities
• Excellent communication and presentation skills
• Experience working directly with clients and exec

📌 Risk Adjustment Specialist (India)
🏢 Advantmed India
📍 India