Remote Risk Adjustment Coder Jobs in Riverside, CA

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

General Duties/Responsibilities (May include but are not limited to):

• Develop, maintain, and audit actuarial models and traditional actuarial methods to support monthly reserve balances, RAF accruals, Part D pass-through accruals, forecasting, trend analysis, and financial projections.
• Analyze healthcare cost and utilization trends, including pharmacy, medical cost drivers, claim adjudication, and utilization management KPIs.
• Support pricing, reserving, and financial planning activities, including budget and forecast cycles; recommend changes to methodologies based on changing circumstances and operational deviations.
• Collaborate with the HealthPlan Economics and Medicare Risk Adjustment teams, as well as cross-functional partners, to review financial performance across markets and translate complex analytics into clear business insights.
• Conduct data-driven analyses to support strategic decision-making, evaluate program performance, and assess risks and opportunities.
• Communicate the purpose and function of actuarial methods and analyses clearly to stakeholders outside the department, including leadership audiences through reports, dashboards, and presentations.
• Ensure data integrity, validation, and reconciliation across multiple data sources to support regulatory and financial reporting requirements.
• Other duties as assigned.

Supervisory Requirements:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

3-5 years minimum of required work experience

Education/Licensure:

Requires a college degree with at least a minor in actuarial science, mathematics, statistics, economics, or equivalent business experience

Other:

Previous knowledge of Medicare Advantage is preferred

ASA designation or has completed the majority of the courses to complete the ASA designation

Programming experience in SQL, R or Python is a plus

Curious mindset and eagerness to learn within the actuarial field and also outside the traditional actuarial field

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information.Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission athttps://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please emailcareers@ahcusa.com.