Quality and Risk Performance Officer, Medicare Advantage

About the role

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: As the Medicare Advantage Quality and Risk Performance Officer, you will work closely with the leadership team to oversee all related activities for Star rating improvement functions. As an innovative thought leader, you must diagnose performance gaps to define organizational strategy and craft annual and long-term plans for improvement. The Medicare Advantage Quality and Risk Performance Officer must use tactical execution to draw conclusions from data, track trends, and determine solutions to identify, create, track, report and manage Stars rating initiatives. The Officer should also be able to clearly articulate solutions, challenges, and results to executives in a professional and formal style. In addition to Stars expertise, we are seeking a results-driven professional with experience in Medicare Advantage risk adjustment and value-based healthcare programs to support performance optimization and revenue integrity. The ideal candidate will have a strong understanding of HCC coding, RAF score optimization, and CMS regulatory requirements, with a proven ability to translate data insights into actionable strategies. Responsibilities include leading risk adjustment initiatives, supporting audit readiness (e.g., RADV), and identifying opportunities to enhance coding capture and care gap closure. Experience working with value-based arrangements, including shared savings models and provider incentive programs, is highly preferred. The candidate should bring a balance of analytical rigor, operational execution, team-building and strategic thinking to advance performance in a complex, highly regulated environment. In addition to hands-on involvement with Stars, Risk Adjustment and Value-based programs, the Officer must be able to foster positive team morale, inspire others to achieve challenging objectives and be extremely collaborative across departments. This is an essential role designed for leaders who want the opportunity to achieve great outcomes. Location: This position is full-time (40-hours/week) Monday-Friday working ONSITE at our Government Programs Complex at 17 Technology Circle, Columbia, SC location.