Risk Adjustment Program Consultant


This position is responsible for regulatory management and leadership of complex and evolving regulatory activities to support Actuarial operational needs and deliverables; serves as subject matter expert in cross functional teams; facilitate and participate in evaluation, development and implementation of new or modified strategies, processes, and operational methods and solutions in relation to business objectives, decisions and statutes, regulations and/or sub-regulatory guidance requirements.


Bachelor degree and 5 years of experience in business; or 9 years' experience in related field.
• 3 years of regulatory experience.
Experience providing support to senior staff in process re-engineering and strategic problem-solving.
• Experience conducting analyses and developing, executing and communicating strategic and operational impacts.
• Creative thinking skills.
• Experience providing strategic and tactical direction based on quantitative and qualitative analyses.
• Knowledge of the regulatory process and health care industry business requirements, processes, functions and drivers.
• Experience communicating and providing support to senior level staff in process re-engineering and strategic problem-solving.
• Knowledge of enterprise business operations.
• Experience managing multiple projects and project teams.
• Effective skills in both verbal and written communication, including facilitation and presentations.
• Effective interpersonal skills.
• Strong organizational skills and detail oriented.
• Problem resolution experience and skills dealing with internal and external customer needs.
• Handle and manage multiple tasks and projects simultaneously.
• Experience working independently and responding to rapidly changing priorities to achieve goals and objectives in a timely manner.
• Skills to operate in cross-functional teams.
• PC proficiency to include Microsoft Word, Excel and PowerPoint.


• Working knowledge of business process model and organizational functions.
Working knowledge of the Affordable Care Act and Reinsurance and Commercial and Medicare Risk Adjustment programs.
Understand impact of CMS Risk Adjustment RAPS, EDPS and EDGE server submissions
Strong Data Management Skills
Intermediate knowledge of Excel ad Access Databases
Ability to manage multiple data sources, provider groups and vendors
Ability to coordinate between multiple internal and external business partners.




HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Government Programs, Regulatory & Compliance, Other Job Type Full-Time Regular Location IL - Chicago, TX - Richardson, MT - Helena, OK - Tulsa, NM - Albuquerque

Meet Some of HCSC's Employees

Allison M.

Internal Auditor

Allison audits operational and financial data throughout the business, helping to expose and mitigate risks, ensure compliance, and add value to HCSC’s operations as a whole.

Rosa Y.

Claims Examiner

Rosa works to process claims that stop due to system edits—researching the edits, correcting the errors, and completing the claims to help members and providers get paid.

Back to top