Senior Risk Adjustment Operations Associate (Healthcare)

TL;DR

Senior Risk Adjustment Operations Associate (Healthcare): Leading the intake and administrative phase of the risk adjustment external audit pipeline with an accent on document classification, validation, and AI-native tools. Focus on optimizing data abstraction workflows, conducting quality assurance, and leveraging BI tools for operational reporting.

Location: Remote (USA)

Salary: $58,000 - $83,000 / year

Company

An all-in-one healthcare company combining compassion, insurance, clinical care, and technology to improve the well-being of older Americans.

What you will do

• Manage the end-to-end administrative review process, including document triage, classification, and technical execution.
• Coordinate daily activities of team members and partner with internal management to align assignments.
• Oversee and refine the use of AI-native tools for automated administrative information extraction.
• Perform detailed quality assurance checks to ensure the accuracy of work output.
• Extract and analyze workstream data using SQL, Looker, or other BI tools to deliver metrics and error trends.
• Document and update standard operating procedures (SOPs) to ensure operational consistency.

Requirements

• Must be based in the USA.
• Proven experience in operations with a strong problem-solving mindset and ability to adapt.
• Strong attention to detail and ability to perform meticulous QA under time-sensitive conditions.
• Proficiency in pulling and analyzing data using spreadsheets and database query tools.
• Experience managing high-volume workflows and collaborating with offshore or distributed teams.
• Excellent communication skills for working across cross-functional teams.

Nice to have

• Bachelor’s degree in Healthcare Administration, Health Information Management (HIM), Business, or a related field.
• Familiarity with healthcare data and ICD-10-CM medical diagnosis codes.
• Experience transforming operations through AI-enabled workflows.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility.
• Comprehensive 401K program.