Consultant - Risk Adjustment Operations

Overview

Wakely, an HMA company, is seeking a highly motivated Risk Adjustment Consultant with hands-on experience supporting or leading health plan operations in both ACA and Medicare Advantage (MA). This role will be instrumental in managing client engagements, coordinating internal teams, driving strategic initiatives, and contributing to the continued growth of Wakely’s risk adjustment service offerings. The ideal candidate combines operational expertise, strong communication skills, and the ability to translate complex concepts into clear, actionable insights for clients.

 

Key Responsibilities: 

• Client Leadership & Communication:
  • Serve as a primary point of contact for clients, collaborating with actuarial, coding, data, and operational experts to synthesize complex analyses and communicate them clearly.
• Project & Workflow Management:
  • Develop, manage, and execute project timelines to ensure high-quality, on-time deliverables across multiple engagements.
• Product & Tool Proficiency:
  • Learn and apply Wakely tools, products, and methodologies to support client needs and internal initiatives.
• Business Development Support:
  • Assist with new business opportunities including RFP responses, proposal development, and strategic scoping discussions.
• Risk Adjustment Operations Oversight:
  • Help guide and manage activities across the risk adjustment ecosystem, including coding operations, provider education, and operational assessments.
• Cross-Functional Collaboration:
  • Partner closely with internal actuarial, coding, operations, and data engineering teams to deliver integrated and comprehensive client solutions.

What We're Looking For:

• Deep experience supporting or leading ACA and MA risk adjustment operations within a health plan or consulting environment.
• Strong understanding of the full risk adjustment lifecycle, including coding, submissions, analytics, provider engagement, and regulatory requirements.
• Strategic mindset with the ability to anticipate market or regulatory changes and turn them into actionable client strategies.
• Ability to build trust, foster strong client relationships, and develop a professional network.
• Passion for developing team members through mentoring, guidance, and knowledge-sharing.
• Excellent written and verbal communication skills, with proven success working across cross-functional teams.

Job Summary

The Consultant I is responsible for providing analytical support and consulting services to clients. This role involves performing data analysis, developing financial models, and assisting in the design and implementation of healthcare strategies. The Consultant I will work closely with senior actuarial staff and clients to deliver actionable insights that support the client’s business objectives.

Responsibilities

Work Performed and Job Requirements

• Data Analysis and Modeling:
  • Conduct detailed data analysis to support client projects, including claims data, healthcare utilization, and cost projections.
  • Develop and maintain financial models to assess the impact of various healthcare strategies, policies, and programs.
  • Perform risk assessments and support the development of pricing strategies for healthcare products.
• Client Management:
  • Collaborate with senior consultants and actuarial staff to understand client needs and objectives.
  • Assist in the development of recommendations and solutions that address client-specific challenges.
  • Prepare and present reports, presentations, and other deliverables that effectively communicate findings and recommendations to clients.
• Project Support:
  • Participate in the design and implementation of client projects, ensuring that all work is completed on time and meets quality standards.
  • Support project management activities, including tracking progress, managing timelines, and coordinating with other team members.
  • Assist in the preparation of proposals, project plans, and other project-related documentation.
• Healthcare Industry Knowledge:
  • Stay informed about industry trends, regulatory changes, and emerging issues in the healthcare sector.
  • Apply industry knowledge to client projects, ensuring that recommendations are relevant and timely.
  • Support internal knowledge sharing by contributing to team discussions and training sessions.
• Collaboration and Communication:
  • Work closely with actuarial analysts, senior consultants, and other team members to ensure a collaborative approach to client projects.
  • Communicate effectively with internal and external stakeholders, ensuring that project objectives and deliverables are clearly understood.
  • Contribute to the development of client relationships through professionalism and a strong understanding of client needs.
• All other duties as assigned.

Qualifications

Education/Training

Minimum of a bachelor’s degree in mathematics, statistics, economics, actuarial science, or a related field required.

 

Experience

Minimum of 2 years of experience healthcare consulting, actuarial analysis, or a related field required.

 

Knowledge, Skills and Abilities

• Strong analytical skills, with experience in data analysis, financial modeling, and risk assessment.
• Proficiency in Excel and experience with actuarial software or data analysis tools (e.g., SAS, R, SQL) is preferred.
• Solid understanding of healthcare industry trends, regulations, and financial principles.
• Excellent written and verbal communication skills, with the ability to present complex information clearly and effectively.
• Strong problem-solving abilities and attention to detail.
• Ability to work independently and as part of a team in a fast-paced, dynamic environment.

 

EEO

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Additional Info

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