You handle senior risk-adjustment work at health plans, ACOs, or healthcare-delivery organizations — analyzing member risk scores, supporting CMS submissions, and the technical work behind risk-adjusted payments under Medicare Advantage, Marketplace, or Medicaid programs.
You spend most weeks between claims data, encounter submissions, and risk-score calculations — analyzing member-level risk scores, supporting CMS or state submissions, investigating documentation gaps, mentoring junior analysts on technical work. You're often at the intersection of healthcare-data analysis and CMS submission requirements. Submission accuracy and risk-score outcomes anchor the visible measures.
Where it gets demanding is the CMS-attention exposure of risk-adjustment work — RADV audits, accuracy expectations, and the multi-year impact of submission decisions. Variance across employers is sharp: at major health insurers senior risk-adjustment analysts work within structured CMS-compliant programs; at growth-stage health plans the senior analyst often shapes program direction directly.
It fits people who are analytically deep, regulatorily fluent, and patient through CMS-submission cycles. The trade-off is the audit-attention exposure typical of senior risk-adjustment work. Healthcare-data credentials and CMS-program training anchor advancement.
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View all Business Operations roles →You handle senior risk-adjustment work at health plans, ACOs, or healthcare-delivery organizations — analyzing member risk scores, supporting CMS submissions, and the technical work behind risk-adjusted payments under Medicare Advantage, Marketplace, or Medicaid programs.
Median pay for a Senior Risk Adjustment Analyst is about $106K nationally, with the field ranging roughly from $62K to $182K depending on experience, employer, and metro (BLS).
Employment in this field is projected to grow about 6.5% through 2034, with roughly 56,320 people working in it today (BLS).
Closely related roles include Risk Management Director, Risk Adjustment Analyst, and Senior Risk Model Auditor.
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