H-1B Visa Risk Operations Specialist Jobs
Risk Operations Specialist roles qualify for H-1B visa sponsorship as specialty occupations requiring at least a bachelor's degree in finance, statistics, business analytics, or a related field. Financial services, fintech, and insurance employers file LCAs regularly for this title, making it a viable target for H-1B holders and cap-season applicants alike.
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Get Access To All JobsPosition Description:
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Manager, Risk Adjustment Operations provides end-to-end operational management, delivery and support to new and existing MA and ACA Risk Adjustment Programs. Working closely with the Director, Risk Adjustment Programs, this position drives execution of operational priorities, manages program performance, and ensures timely delivery of strategic initiatives through data-driven decision making, cross-functional coordination, and operational accountability. The manager will be responsible for professional coaching and mentoring of program team members while fostering continuous process improvement.
Responsibilities:
- Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring project milestones, regulatory deadlines, and operational deliverables are completed on schedule.
- Develop and maintain integrated project plans, operational calendars, risk logs, and status reporting to support successful program execution.
- Monitor program performance through dashboards, KPIs, and operational metrics; identify trends, escalate risks, and recommend data-driven improvements.
- Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance and vendor partners to ensure successful execution of operational priorities.
- Hold internal teams and external vendors accountable for operational performance, deliverables, timelines, service level expectations, and issue resolution.
- Proactively identify operational barriers and develop mitigation plans to minimize impact to program performance.
- Strategic vision to align business operations with broader organizational goals.
- Business acumen to drive growth and success through data-driven decisions.
- Lead operational vendor onboarding and offboarding activities, support vendor evaluations and RFP processes, and partner with procurement and other stakeholders to ensure successful implementation and ongoing operational performance.
Qualifications
Skills:
- Strong verbal and written communication skills, including the ability to communicate complex operational issues clearly to business partners and leadership.
- Strong organizational and project management skills, with demonstrated ability to manage multiple priorities, deadlines, dependencies, and deliverables.
- Ability to lead cross-functional initiatives and build effective working relationships across internal departments and external vendor partners.
- Strong analytical and problem-solving skills, including demonstrated ability to interpret dashboards, key performance indicators, and operational reporting to monitor performance, identify risks, and drive operational decision-making.
- Strong business acumen, including the ability to understand operational, financial, contractual, and regulatory considerations.
- Ability to proactively identify risks, remove barriers, develop mitigation plans, and escalate issues appropriately.
- Strong vendor management skills, including experience in supporting vendor evaluation, onboarding, implementation, performance monitoring, and transitions.
- Ability to work independently, exercise sound judgement, and drive accountability in a fast-paced, deadline-oriented environment.
- Proficiency with Microsoft Office applications, including advanced Excel skills; ability to interpret and leverage Power BI or other business intelligence reporting preferred.
Knowledge:
- Working knowledge of Medicare Advantage and ACA Risk Adjustment regulations and payment methodologies.
- Working knowledge of industry standards and best practices for Risk Adjustment operations.
- Working knowledge of cross-functional Risk Adjustment operational processes, including provider engagement, analytics, coding, vendor management, and regulatory compliance.
Experience:
- 5 years of Operations and/or Program management.
- 3 years of Risk Adjustment Operations or Program Management.
- Experience leading complex, cross-functional operational initiatives involving multiple stakeholders and competing priorities.
- Experience supporting vendor selection, RFP processes, business requirements, Statement of Work (SOWs), implementation, onboarding, and ongoing vendor performance management.
- Experience monitoring operational performance and driving execution to meet regulatory deadlines and business objectives.
- 1 year staff, team lead or project lead experience.
- Experience supervising staff and provider operational leadership across cross-functional programs or initiatives preferred.
Education and Certifications:
- Bachelor’s degree in business administration, Healthcare Administration, Public Health, Health Information Management, Finance, Economics or 9 years relevant and progressive experience in lieu of bachelor's degree.
- Lean Six Sigma or other operational excellence/process improvement certification preferred.
Physical Demands:
- While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
- The employee must be able to work over 40 hours per week.
- The employee must occasionally lift and/or move up to 5 pounds.
About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Position Description:
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The Manager, Risk Adjustment Operations provides end-to-end operational management, delivery and support to new and existing MA and ACA Risk Adjustment Programs. Working closely with the Director, Risk Adjustment Programs, this position drives execution of operational priorities, manages program performance, and ensures timely delivery of strategic initiatives through data-driven decision making, cross-functional coordination, and operational accountability. The manager will be responsible for professional coaching and mentoring of program team members while fostering continuous process improvement.
Responsibilities:
- Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring project milestones, regulatory deadlines, and operational deliverables are completed on schedule.
- Develop and maintain integrated project plans, operational calendars, risk logs, and status reporting to support successful program execution.
- Monitor program performance through dashboards, KPIs, and operational metrics; identify trends, escalate risks, and recommend data-driven improvements.
- Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance and vendor partners to ensure successful execution of operational priorities.
- Hold internal teams and external vendors accountable for operational performance, deliverables, timelines, service level expectations, and issue resolution.
- Proactively identify operational barriers and develop mitigation plans to minimize impact to program performance.
- Strategic vision to align business operations with broader organizational goals.
- Business acumen to drive growth and success through data-driven decisions.
- Lead operational vendor onboarding and offboarding activities, support vendor evaluations and RFP processes, and partner with procurement and other stakeholders to ensure successful implementation and ongoing operational performance.
Qualifications
Skills:
- Strong verbal and written communication skills, including the ability to communicate complex operational issues clearly to business partners and leadership.
- Strong organizational and project management skills, with demonstrated ability to manage multiple priorities, deadlines, dependencies, and deliverables.
- Ability to lead cross-functional initiatives and build effective working relationships across internal departments and external vendor partners.
- Strong analytical and problem-solving skills, including demonstrated ability to interpret dashboards, key performance indicators, and operational reporting to monitor performance, identify risks, and drive operational decision-making.
- Strong business acumen, including the ability to understand operational, financial, contractual, and regulatory considerations.
- Ability to proactively identify risks, remove barriers, develop mitigation plans, and escalate issues appropriately.
- Strong vendor management skills, including experience in supporting vendor evaluation, onboarding, implementation, performance monitoring, and transitions.
- Ability to work independently, exercise sound judgement, and drive accountability in a fast-paced, deadline-oriented environment.
- Proficiency with Microsoft Office applications, including advanced Excel skills; ability to interpret and leverage Power BI or other business intelligence reporting preferred.
Knowledge:
- Working knowledge of Medicare Advantage and ACA Risk Adjustment regulations and payment methodologies.
- Working knowledge of industry standards and best practices for Risk Adjustment operations.
- Working knowledge of cross-functional Risk Adjustment operational processes, including provider engagement, analytics, coding, vendor management, and regulatory compliance.
Experience:
- 5 years of Operations and/or Program management.
- 3 years of Risk Adjustment Operations or Program Management.
- Experience leading complex, cross-functional operational initiatives involving multiple stakeholders and competing priorities.
- Experience supporting vendor selection, RFP processes, business requirements, Statement of Work (SOWs), implementation, onboarding, and ongoing vendor performance management.
- Experience monitoring operational performance and driving execution to meet regulatory deadlines and business objectives.
- 1 year staff, team lead or project lead experience.
- Experience supervising staff and provider operational leadership across cross-functional programs or initiatives preferred.
Education and Certifications:
- Bachelor’s degree in business administration, Healthcare Administration, Public Health, Health Information Management, Finance, Economics or 9 years relevant and progressive experience in lieu of bachelor's degree.
- Lean Six Sigma or other operational excellence/process improvement certification preferred.
Physical Demands:
- While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
- The employee must be able to work over 40 hours per week.
- The employee must occasionally lift and/or move up to 5 pounds.
About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
See all 125+ H-1B Visa Risk Operations Specialist Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new H-1B Visa Risk Operations Specialist Jobs.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship as a Risk Operations Specialist
Align your degree to the SOC code
Risk Operations roles are typically filed under SOC 13-2099 or 13-2061. Pull the O*NET profile for your target title and confirm your degree field maps directly to its listed education requirements before applying.
Search LCA filings by occupation code
Use Migrate Mate to filter employers by LCA filing history for risk and compliance roles. You'll see which companies have sponsored this title recently, so you're targeting proven sponsors rather than guessing from job postings.
Benchmark your offer against prevailing wage
Before signing an offer letter, run your job location and SOC code through the OFLC Wage Search. If the offer falls below the Level II or III wage, USCIS may issue an RFE on the LCA certification.
Flag cap-exempt employers during your search
Nonprofits, government research entities, and universities can hire H-1B workers outside the annual cap. Risk operations functions exist at these institutions too, and a cap-exempt role means no lottery exposure.
Request premium processing before your OPT expires
If you're transitioning from OPT, confirm your employer will file with USCIS premium processing. Standard processing can run several months, and a cap-gap extension only protects status through September 30 of the fiscal year.
Document quantitative project scope in your application
H-1B petitions for risk roles are stronger when the job description references specific analytical tools, regulatory frameworks, or model validation workflows. Work with your employer's HR team to include this detail in the I-129 support letter.
H-1B Visa Risk Operations Specialist: Frequently Asked Questions
Does a Risk Operations Specialist role qualify as an H-1B specialty occupation?
Yes, provided the employer requires at least a bachelor's degree in a directly related field such as finance, economics, statistics, or mathematics. Roles that accept any degree regardless of field can face USCIS scrutiny on specialty occupation grounds, so the job description must specify a field-specific requirement, not just a general degree.
Which industries sponsor H-1B visas most often for this role?
Financial services firms, fintech companies, insurance carriers, and payment processors file LCAs most frequently for risk operations titles. Banks and credit card issuers with large fraud and credit risk teams are consistent sponsors. You can confirm which employers have active filing history by searching on Migrate Mate before applying.
Can I transfer my H-1B to a new Risk Operations Specialist role at a different employer?
Yes. Under H-1B portability, you can start working for a new employer once they file a transfer petition with USCIS, without waiting for approval, as long as your previous H-1B was approved and you've maintained valid status. The new employer must file a new LCA and I-129 covering the specific risk operations role.
What happens if my Risk Operations Specialist job description changes significantly after my H-1B is approved?
A material change in duties, location, or classification requires an amended H-1B petition before the change takes effect. Adding new responsibilities that shift your SOC code, or moving to a different worksite metro area, each trigger an amendment filing with a new LCA. Proceeding without amending puts your status at risk during any future USCIS audit.
How do I verify that an employer is likely to sponsor H-1B for this title?
Check the employer's DOL LCA disclosure data, which shows every H-1B labor condition application filed, including job title, worksite, and wage level. Employers with repeated filings for risk, compliance, or operations analyst titles are far more likely to have an established sponsorship process than those with no filing history.