VP, Sales (Risk & Quality)

Accountabilities: • Drive new revenue opportunities and support expansion within existing client accounts across risk adjustment and quality solutions, with a focus on retrospective and prospective risk adjustment offerings delivered through SaaS and BPaaS models.

• Build and maintain relationships with senior decision-makers at health plans, understanding their strategic priorities, operational challenges, technology environments, and business objectives to align appropriate solutions.

• Develop and execute market-specific sales strategies using industry intelligence, competitive insights, customer needs, and market growth opportunities to support revenue objectives and sales targets.

• Identify, qualify, and advance strategic prospects by working with Sales, Client Services, Marketing, Sales Operations, Product, Technology, and other internal stakeholders to assess opportunities, develop positioning, and coordinate pursuit strategies.

• Manage complex sales processes from initial discovery through presentations, demonstrations, workflow analysis, solution alignment, commercial negotiations, contracting, and CRM documentation.

• Support healthy pipeline development by identifying target organizations, cultivating executive-level relationships, networking within relevant healthcare associations, and creating introductions to additional decision-makers and operational stakeholders.

• Support RFI and RFP responses related to Risk and Quality, coordinating with internal subject-matter experts to develop accurate, competitive, and compliant proposals.

• Collaborate cross-functionally to support successful client onboarding, ongoing customer satisfaction, product evolution, and long-term account relationships.

• Monitor healthcare industry trends, customer challenges, competitive developments, and emerging market opportunities to strengthen sales positioning and identify areas for expansion.

• Track and interpret CMS regulatory developments, including relevant STAR, HEDIS, ODAG, and HPMS requirements, as well as changes in risk adjustment coding and quality programs that may influence customer needs.

• Provide accurate pipeline forecasts, sales activity reporting, opportunity updates, and risk assessments to senior sales leadership and relevant client-facing teams.

• Represent the organization professionally within the healthcare technology and payer ecosystem through industry engagement, customer meetings, presentations, networking, and thought leadership.

Requirements:

• 15+ years of experience in Risk Adjustment, Stars, HEDIS, Quality Solutions, healthcare SaaS/BPaaS, or enterprise healthcare technology, with substantial knowledge of Medicare Advantage, ACA, and/or Managed Medicaid risk adjustment strategies.

• Demonstrated experience with retrospective and prospective risk adjustment programs, quality improvement solutions, CMS requirements, STAR ratings, and HEDIS.

• Strong healthcare subject-matter expertise, including an understanding of payer and provider dynamics, risk adjustment, quality programs, and value-based care.

• Experience with BPaaS and SaaS delivery models in risk adjustment outsourcing or related healthcare services, including the ability to discuss build-versus-buy considerations with health plan stakeholders.

• Proven track record supporting or leading complex, multi-stakeholder enterprise sales processes and achieving or contributing to sales revenue targets.

• Strong technical aptitude and understanding of enterprise healthcare transaction systems, health plan technologies, and healthcare management information systems.

• Excellent presentation, communication, and interpersonal skills, with the ability to translate complex healthcare and technical concepts into clear business value for executive and non-technical audiences.

• Strong analytical, consultative, and problem-solving capabilities, with a focus on developing solutions aligned with customer requirements and strategic objectives.

• Ability to work independently, manage multiple strategic opportunities, and collaborate effectively across geographically distributed and cross-functional teams.

• Willingness and ability to travel approximately 33% within the assigned territory and as required for customer and business needs.

• Remote work capability, including comfort working across multiple time zones and spending extended periods using computer and video-conferencing technology.

Benefits:

• Annual US base salary range of $233,000–$254,000, with final compensation determined based on factors such as skills, experience, qualifications, and education.

• Full-time, permanent employment.

• Remote position within the United States.

• Approximately 33% travel, providing opportunities for direct engagement with customers, prospects, and industry stakeholders.

• Opportunity to work at the intersection of healthcare technology, risk adjustment, quality improvement, SaaS/BPaaS, and enterprise sales.

• Exposure to senior healthcare executives and complex strategic sales opportunities across Medicare Advantage, ACA, and Managed Medicaid markets.

• Opportunity to contribute to product positioning, market expansion, client strategy, and the evolution of healthcare technology solutions.

• Flexible remote work environment supporting collaboration across multiple time zones.

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