Analyst, Risk Adjustment at Oscar · LumiJobs

Responsibilities

Risk Adjustment accounts for differences in members’ health needs and expected cost of care. Accurate and complete clinical documentation helps ensure that a member’s health status is appropriately represented. Prospective Risk Adjustment focuses on proactively supporting opportunities for healthcare providers to review members’ health information and accurately document conditions addressed during clinical care, in accordance with applicable clinical coding and documentation requirements. These efforts may include sharing relevant clinical information with providers at the point of care, conducting virtual or in-home health assessments, and providing reports that identify historical or suspected conditions for provider review and clinical validation.
The Analyst, Risk Adjustment supports the day-to-day execution and performance of Prospective Risk Adjustment programs. This role partners with internal teams and external vendors to ensure operational workflows are functioning as intended, program data and reporting are accurate, claims are processed appropriately, and operational issues are identified and resolved in a timely manner. The analyst will support a portfolio of initiatives including Point-of-Care tools, Virtual Health Assessments (VHA), In-Home Assessments (IHA), and provider reporting to support the review of member conditions. This role is well suited for an analytical, detail-oriented professional interested in developing expertise in Risk Adjustment and healthcare operations.
Work Location: This position is based in our New York, NY office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid
Pay Transparency: The base pay for this role is: $75,348- $98,894 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Prospective Risk Adjustment Program Operations (30%) – Support daily operations across prospective Risk Adjustment programs, including Point-of-Care tooling, VHA, IHA, and provider gap-reporting initiatives. Monitor program activity and workflows to ensure processes are functioning as intended; investigate operational issues and coordinate resolution or escalation as appropriate.
Vendor Operations & Support (25%) – Support the day-to-day operational needs of external vendors. Coordinate recurring deliverables and data exchanges, respond to operational questions, track issues and action items, and partner with vendors and internal stakeholders to drive timely resolution.
Reporting, Data Analysis & Reconciliation (20%) – Develop and maintain recurring reports, trackers, and analyses to monitor program performance, including assessment activity, provider participation, vendor performance, claims activity, and other key operational metrics. Perform data validation and reconciliation across internal and vendor data sources to identify discrepancies, trends, and opportunities for operational improvement.
Point-of-Care & Provider Programs (15%) – Support programs that provide relevant member health information, including historical and suspected conditions, to healthcare providers for review and clinical validation. Support Point-of-Care tools and provider reporting initiatives and assist with resolving related data, reporting, and workflow issues.
Member & Claims Operations (10%) – Support member-level program operations, including reviewing and processing appropriate exclusions from VHA and IHA programs. Monitor and reconcile claims associated with prospective Risk Adjustment initiatives to ensure appropriate processing and payment; investigate discrepancies and partner with relevant teams to support resolution.

Analyst, Risk Adjustment

Responsibilities

Qualification

Required

Preferred

Benefits

Company

Oscar

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