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Medicare Risk Adjustment Jobs in Michigan (NOW HIRING)

Epitec

Workers Compensation Plant Rep II

Dearborn, MI · On-site

$29/hr

Calculate and issue benefit payments ; approve adjustments and settlements within authority level ... Escalate complex or high-risk cases to leadership as appropriate Required Qualifications * 3-5+ ...

Hospice of Michigan

Social Worker

Kalamazoo, MI · On-site

... adjustments to illness or terminal prognosis, anticipatory grief, stress, care giving concerns ... Understands and complies with Hospice Medicare and Medicaid conditions of participation. * Complies ...

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Medicare Risk Adjustment information

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$11

$19

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How much do medicare risk adjustment jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for medicare risk adjustment in Michigan is $19.54, according to ZipRecruiter salary data. Most workers in this role earn between $14.04 and $23.65 per hour, depending on experience, location, and employer.

What are jobs in Medicare Risk Adjustment?

Jobs in Medicare risk adjustment include work in data analytics, consulting, insurance, and closely related industries. Your duties and responsibilities differ depending on the type of work. For example, as a Medicare risk-adjustment consultant, you provide advice and recommendations to healthcare organizations or an insurance provider on how to mitigate risk across a customer pool. Data analytics and statistics specialists gather and analyze insurance and Medicare data and documentation from hospitals, healthcare providers, and other medical care facilities that accept Medicare. This includes reviewing different types of diagnosis and comparing patient chart information. Some health care providers have in-house risk adjustment workers, while others contract with outside consulting and analytics firms.

What is the difference between Medicare Risk Adjustment vs Medicare Coding Specialist?

AspectMedicare Risk AdjustmentMedicare Coding Specialist
Primary FocusAssessing patient health risk scores for reimbursementAccurately coding medical diagnoses and procedures
Required CredentialsCertifications in risk adjustment or coding, often CPC or RHITCertifications like CPC, CCS, or RHIT
Work EnvironmentHealth plans, risk adjustment companies, healthcare providersHospitals, clinics, billing departments
Industry UsageUsed for Medicare Advantage plan reimbursementsUsed for medical billing and claims processing

While both roles involve healthcare coding and require similar certifications, Medicare Risk Adjustment focuses on evaluating patient health data to determine reimbursement levels, whereas Medicare Coding Specialists concentrate on accurately coding diagnoses and procedures for billing purposes.

What is Medicare Risk Adjustment?

Medicare Risk Adjustment is a process used by the Centers for Medicare & Medicaid Services (CMS) to adjust payments to Medicare Advantage plans based on the health status and demographic characteristics of their enrolled beneficiaries. The goal is to ensure that plans receive appropriate compensation for taking care of members with varying levels of health risk. This system uses diagnosis codes and other data to predict future healthcare costs, encouraging plans to provide comprehensive care and accurately document patient conditions.

What are some common challenges faced by professionals working in Medicare Risk Adjustment roles?

Professionals in Medicare Risk Adjustment often encounter challenges such as staying current with frequently changing CMS regulations, ensuring the accurate capture and documentation of patient diagnoses, and collaborating effectively with providers to optimize risk scores. The role requires meticulous attention to detail when reviewing medical records and coding, as well as strong communication skills to educate and support healthcare teams. Additionally, there can be pressure to meet strict deadlines for data submission and to ensure compliance with audit standards.

What are the key skills and qualifications needed to thrive in Medicare Risk Adjustment?

To excel in Medicare Risk Adjustment, you need a solid understanding of medical coding (especially ICD-10), healthcare regulations, and risk adjustment methodologies, often supported by credentials like CRC or CPC certifications. Familiarity with data analytics platforms, EHR systems, and specialized risk adjustment software is typically required. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for interpreting complex clinical data and collaborating across teams. These competencies ensure accurate risk scores, compliance with CMS requirements, and optimal financial outcomes for healthcare organizations.
More about Medicare Risk Adjustment jobs
What are the most commonly searched types of Medicare Risk Adjustment jobs in Michigan? The most popular types of Medicare Risk Adjustment jobs in Michigan are:
What are popular job titles related to Medicare Risk Adjustment jobs in Michigan? For Medicare Risk Adjustment jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Michigan look for? The top searched job categories for Medicare Risk Adjustment jobs in Michigan are:
Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 9% Part Time, 1% Temporary, and 4% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $40,645 per year, or $19.5 per hour.

Workers Compensation Plant Rep II

Epitec

Dearborn, MI • On-site

$29/hr

Contractor

Medical, Dental, Vision, Retirement, PTO

Re-posted 12 days ago

Job description

  • Location: Dearborn, Michigan
  • Type: Contract
  • Job #103867

We're #HIRING!
Job Title: Workers Compensation Plant Rep II
Location: Dearborn, MI (Onsite)
Job Type: HR/Claims Rep
Shift: 8:00am-4:30pm
Expected hours per week (must include "per week"): 40/week
Pay Range (must include "per hour"): $29.00/hr
Job Description:
About the Role
We are seeking an experienced Workers' Compensation Claims Handler to serve as the primary point of contact for all claims at a plant location. In this role, you will manage a full caseload of workers' compensation claims-focusing on high-quality claim handling, strong customer service, and effective cost control.
This is a hands-on, onsite position where you'll work closely with employees, leadership, medical providers, and legal partners to ensure claims are handled accurately, efficiently, and in compliance with state regulations.
Key Responsibilities
  • Manage a full caseload of workers' compensation claims, including more complex and higher-severity cases
  • Investigate claims by gathering facts, statements, and documentation to determine exposure and compensability
  • Develop and execute strategic claim action plans to drive timely and cost-effective resolution
  • Handle lost-time claims, including wage calculations and ongoing indemnity management
  • Establish and maintain appropriate reserves, ensuring accuracy throughout the life of the claim
  • Calculate and issue benefit payments; approve adjustments and settlements within authority level
  • Prepare and submit state filings in compliance with statutory requirements
  • Coordinate with vendors for investigation, medical management, and litigation support
  • Utilize cost containment strategies (e.g., vendor partnerships, medical management tools)
  • Manage claim recoveries including subrogation, Second Injury Fund, and Social Security/Medicare offsets
  • Report claims to excess carriers when applicable
  • Communicate proactively with claimants, plant leadership, HR, and external partners regarding claim status
  • Maintain accurate, well-documented claim files and ensure proper claims coding
  • Escalate complex or high-risk cases to leadership as appropriate

Required Qualifications
  • 3-5+ years of Workers' Compensation claims handling experience
  • Proven experience handling lost-time claims and higher-exposure cases
  • Strong knowledge of claims investigation, reserving, and benefit administration
  • Ability to manage a full caseload independently
  • Excellent communication, organization, and decision-making skills
  • Comfortable working onsite in a plant/manufacturing environment

Preferred Qualifications
  • Bachelor's degree (or equivalent experience)
  • Experience working in a self-insured or plant-based environment
  • Familiarity with cost containment strategies and vendor management

Why This Role
  • Opportunity to be the lead claims professional onsite
  • High visibility with plant leadership and direct impact on operations
  • Hands-on role with ownership of claims from intake through resolution
  • Collaborative, team-oriented environment with strong cross-functional exposure

Benefits: 80 hours paid time off, and medical insurance contributions, dental vision and our 401k retirement savings plan
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