Vice President, Risk Adjustment & Value Based Care

Company Overview and Culture

EXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit www.exlservice.com.



For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change. The business operates within four business units: Insurance, Health, Analytics, and Emerging businesses.



About EXL Health

We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.



EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.



We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.



Job Description:

Seeking a VP(2) of Risk Adjustment & Value Based Care (VBC) to lead EXL’s payer and provider solution(s) delivery and go-to-market strategies. This role includes overseeing EXL’s award winning “Best in KLAS 2022 Award - Software and Professional Services” Risk Adjustment and Quality Management team. In this role, you will be responsible for leading the strategy, development, value creation, market leadership, and customer success in VBC solution development and delivery.



Primary responsibilities include developing and maintaining solution and product strategies and roadmap, driving solutions from idea to launch, being accountable for their success, and actively partnering and collaborating with customers, service delivery, technology, sales, marketing, and other parts of the organization to deliver on success metrics, including but not limited to revenue growth, profitability and customer satisfaction.



Only candidates with prior VBC, risk adjustment and quality management experience across Medicaid, Medicare and ACA Exchange lines of business will be considered for this role.



Position Purpose:

• As the solution steward, develop, maintain and deliver the risk adjustment and quality management strategy and results, partnering with cross-functional stakeholders to ensure execution and meeting of customer requirements.


• Lead collaboration across the Health business unit to develop an effective VBC strategy, encompassing its strengths in payments, clinical, analytics, and digital/AI.


• Be responsible for product oversight of EXLClarityTM platform, EXL’s risk adjustment platform. Includes roadmap development and go-to-market campaigns in a pragmatic framework.


• Actively generate and pursue market opportunities in conjunction with sales.


• Actively partner with customers, vendors/partners, and internal departments (e.g., customers, sales, marketing, client success, solutioning, services, training, support and other cross-functional teams) to translate problem statements into solutions.


• Work with sales, finance, and leadership teams to determine customer solution, pricing and packaging approach.


• Serve as SME for sales enablement activities.


• Conduct market research to further clarify product strengths and gaps to help feed into future product definitions/strategy, document market landscape, and articulate product business requirements.


• Articulate core value proposition and competitive advantage to the market by working with marketing to build compelling sales and marketing presentations that properly position the products.


• For defined strategy, determine when to buy, build or partner for product enhancements.


• As P&L owner, actively measure and evaluate product performance to determine opportunities for revenue growth, improved customer performance/value and internal cost optimization.


• Measure adoption and utilization of all features, products, and services to determine business value to customers and company. Actively work to increase adoption of new products and features.


• Track regulatory changes and deadlines and incorporate updates as needed into product roadmap.


• Prepare executive level updates internally and externally.


• Own all aspects of product life cycle.

Skills and Experience:

• Bachelor’s degree in a relevant field such as healthcare administration, business, or marketing; master’s degree preferred.


• 15+ years of experience in healthcare with focused experience in risk adjustment and quality management products


• Prior experience leading a P&L


• Working knowledge in core product development and management principles, including market analysis, competitive intelligence, and requirements development


• Strong experience and working knowledge of Medicare, Medicaid & Commercial risk adjustment business models and other healthcare related regulatory compliance and policy making entities.


• Knowledge in HEDIS, Medicare Stars, & other quality measures in healthcare


• Prior experience growing a service product line into a scalable business.


• Strong communication skills with comfort in speaking with all levels of employees including executive suite business stakeholders.


• Dynamic leader that embraces change and can bring other along with the change.


• Believes in a non-hierarchical culture of collaboration, transparency, safety, and trust demonstrating ability to work in a matrix environment.


• Not afraid to “roll up the sleeves” going outside comfort zone to learn – pushes teams to do the same.


• Empowers others to fail, learn, and grow.


• Willingness and ability to contribute to industry thought leadership.


• Willingness to be external facing, supporting the client sales team as Risk Adjustment and Quality SME.


• Some travel required for client sales support and industry events.

Our ideal candidate may also have knowledge in:

• Deep understanding of risk scoring models (CMS-HCC, HHS-HCC, CDPS)


• Experience working with healthcare data (claims, encounter submissions, eligibility, etc.) & detailed knowledge of CPT/HCPCS/ICD9/ICD10


• Leading Electronic Medical Records (EMR) systems


• Understanding of digital, AI, NLP, ML

EEO/Minorities/Females/Vets/Disabilities



To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits



Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.



Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.



Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).



EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.