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Senior Risk Adjustment Auditor Jobs (NOW HIRING)

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment ...

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How much do senior risk adjustment auditor jobs pay per year?

As of Aug 10, 2026, the average yearly pay for senior risk adjustment auditor in the United States is $90,973.00, according to ZipRecruiter salary data. Most workers in this role earn between $81,000.00 and $99,500.00 per year, depending on experience, location, and employer.

What is a senior risk adjustment auditor?

Senior Risk Adjustment Auditors are experienced professionals who review medical records and data to ensure accurate coding and documentation for risk adjustment purposes, primarily in healthcare settings. They help organizations comply with government regulations and maximize appropriate reimbursement by identifying and correcting coding errors or gaps. Their role involves analyzing patient data, collaborating with coding teams, and providing feedback or training to improve documentation practices. Senior auditors often have advanced knowledge of ICD-10-CM coding, risk adjustment models (such as HCC), and auditing standards. Their expertise helps healthcare organizations maintain compliance and optimize financial performance.

How does a senior risk adjustment auditor typically collaborate with coding teams and healthcare providers to ensure accurate documentation and coding?

A Senior Risk Adjustment Auditor often works closely with medical coding teams and healthcare providers to review patient records for accuracy and compliance with risk adjustment guidelines. This collaboration may involve providing feedback on documentation quality, clarifying coding ambiguities, and offering training or guidance on best practices. Regular meetings and audits help ensure that everyone is aligned with current regulations and organizational standards. Effective communication and teamwork are essential to maintain high-quality, compliant coding that supports proper reimbursement and patient care.

What are the key skills and qualifications needed to thrive as a senior risk adjustment auditor?

To thrive as a Senior Risk Adjustment Auditor, you need deep expertise in medical coding (ICD-10-CM), risk adjustment methodologies, and a background in healthcare compliance, typically supported by certifications such as CRC, CPC, or CCS-P. Familiarity with auditing platforms, data analysis tools, and electronic medical records systems is crucial. Exceptional attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and effectively collaborate with providers. These competencies ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

What is the difference between Senior Risk Adjustment Auditor vs Risk Adjustment Auditor?

AspectSenior Risk Adjustment AuditorRisk Adjustment Auditor
CertificationsCPMA, RAC, or similarCPMA, RAC, or similar
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsHealthcare providers, insurance companies, auditing firms
Job ResponsibilitiesLeading audits, mentoring, complex data analysisPerforming audits, data review, compliance checks

Both roles require similar certifications and work in healthcare or insurance settings. The Senior Risk Adjustment Auditor typically handles more complex audits, provides mentorship, and takes on leadership tasks, whereas the Risk Adjustment Auditor focuses on executing audits and data analysis. The senior role involves greater responsibility and expertise, often leading to career advancement in risk adjustment auditing.

More about Senior Risk Adjustment Auditor jobs
What cities are hiring for Senior Risk Adjustment Auditor jobs? Cities with the most Senior Risk Adjustment Auditor job openings:
What are the most commonly searched types of Risk Adjustment Auditor jobs? The most popular types of Risk Adjustment Auditor jobs are:
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Senior Risk Adjustment Auditor jobs near you
Infographic showing various Senior Risk Adjustment Auditor job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 69% In-person, 8% Hybrid, and 23% Remote job distribution, with an average salary of $90,973 per year, or $43.7 per hour.

Risk Adjustment Actuary

Blue Cross and Blue Shield of Minnesota

Eagan, MN • On-site

$102K - $138K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Blue Cross Blue Shield Of Minnesota rating

6.0

Company rating: 6.0 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

281st of 304 rated insurance

Job description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

Blue Cross and Blue Shield of Minnesota is hiring a Risk Adjustment Actuary in Eagan, MN.This role is part of the Risk Adjustment Analytics team, which supports enterprise-wide initiativesacross Medicare, ACA Commercial, and Medicaid.This position serves as a key technical leadership role on the team, guiding actuarial assumption development and analysis that support enterprise decision-making.

The Risk Adjustment Analytics team partners across legal, compliance, provider, and actuarial functions to support a broad range of risk adjustment work, including forecasting, pricing, audit support, and strategic initiatives.In this role, you will review and strengthen work before final delivery, help shape forecast assumptions, and support audit defense and proposed changes. You will also translate complex actuarial concepts into clear, actionable insights for business partners and senior leaders.

The ideal candidate is a credentialed actuary with strong actuarial judgment, recent knowledge of CMS model changes, and a consultative mindset. You bring the ability to independently analyze complex data, develop defendable assumptions, and support forecasting, valuation, and strategic decision-making related to risk adjustment.

You are also skilled at working cross-functionally, understanding the business context behind each request, and translating technical findings into meaningful recommendations for non-technical audiences.

Your Responsibilities

  • Research, analyze and interpret actuarial and statistical data and provide technicalassistanceto other departments. This includesidentifyingissues to be researched,determiningaffected areas, estimating theimpactand leading the resolution.

  • Develop mathematical models in connection with other departments to predictimpactof proposed changes. May also be involved in the design of these models.

  • Understand/interpret thefinancial impactof decisions made by retrieving and analyzing claim costs,revenueand/or other relevant data. Participate in the design and implementation of new products and system enhancements by providing data and recommendations toassistin evaluating the impact of the proposed benefit,systemor process changes.

  • Responsible for divisional representation on corporate projects and may have leadership roles on these teams. Independently manage, which may include directing other staff, the retrieval and analysis of data on multiple tasks or projects with little or no management involvement.

  • Act as a resource for other members of the department/division on business issues and maybe responsible fortraining and guidance of Actuarial support personnel or Analysts. Makes satisfactory progress according to the Actuarial Student Program guidelines.

  • Other specific accountabilities as assigned by management.

Required Skills and Experience

  • 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

  • ASA or above.

  • Strong oral and written communication skills.

  • Excellent PC skills. Knowledge of data retrieval languages.

  • Knowledge of BCBSMs databases or industry knowledge.

  • High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

  • Bachelor's degree.

  • FSA preferred.

  • 3+ years of risk adjustment (RA) actuarial experience preferred.

  • Demonstrated knowledge of recent CMS risk adjustment model changes and implications

  • Experience independently analyzing complex data and leading multiple risk adjustment-related projects with minimal oversight

  • Proven ability to develop and refine risk adjustment assumptions, including applying insights from evolving data and regulatory environments

  • Ability to assess the broader risk adjustment landscape and translate findings into clear, actionable assumptions and recommendations

  • Recognized as a subject matter resource for risk adjustment assumption development and strategy

Role DesignationHybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits$102,400.00 - $138,300.00 - $174,200.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

  • Medical, dental, and vision insurance

  • Life insurance

  • 401k

  • Paid Time Off (PTO)

  • Volunteer Paid Time Off (VPTO)

  • And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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