Customer Success Manager - Healthcare Risk Adjustment

Remote (United States)

Job Details

Employment Type: Full Time

Annual Salary: $100,000–$110,000 per year

Final compensation may vary based on geographic market, job-related knowledge, skills, and experience.

About the Role

This Customer Success Manager will be responsible for driving customer goals, business transformation, platform adoption, retention, and revenue expansion across an assigned book of business. The role focuses on building strong strategic partnerships with complex, high-revenue healthcare customers, particularly those involved in ACA HHS CMS RADV Initial Validation Audit programs.

You will serve as the primary customer contact, work closely with executive-level stakeholders, and help customers successfully adopt healthcare technology while achieving measurable project and business outcomes. The position requires a strong understanding of customer workflows, regulatory requirements, project delivery, account health, and risk adjustment operations.

Success in this role depends on strong customer relationships, consultative support, proactive risk management, cross-functional collaboration, and the ability to identify opportunities for renewal and expansion.

What You’ll Do

Strategic Customer Management

• Build long-term, strategic partnerships with complex, high-revenue customers, particularly those involved in ACA HHS CMS RADV Initial Validation Audit programs.
• Manage an assigned book of business and develop a deep understanding of each customer’s value drivers, business goals, workflows, organizational structure, and requirements.
• Serve as the primary point of contact for customers throughout the relationship.
• Engage with customers daily through scheduled meetings, email, and ad hoc calls as needed.
• Develop strong executive-level relationships and provide consultative guidance that supports long-term customer success.

Adoption, Retention, and Growth

• Drive successful adoption of the healthcare technology platform while ensuring a positive customer experience.
• Support customer retention, renewals, and expansion by helping customers achieve measurable value from the platform and related services.
• Develop a deep understanding of available platform capabilities and service offerings.
• Share best practices, provide consultative support, and identify opportunities to expand customer relationships.
• Use Gainsight to create success plans, monitor customer health, and document progress toward defined program goals and milestones.

Customer Performance and Risk Management

• Maintain proactive daily awareness of customer reporting, performance, and alignment with applicable service level agreements.
• Identify performance gaps and develop clear gap-closing plans.
• Analyze customer data and key performance indicators to identify emerging risks or changes in performance trends.
• Monitor customer health and proactively address issues that could affect satisfaction, retention, or program success.
• Apply strong problem-solving skills to technically complex customer relationships and account challenges.

Project and Escalation Management

• Work closely with senior leadership to identify, track, and resolve critical project issues.
• Ensure escalations are clearly defined, prioritized, and actively managed toward outcomes aligned with customer business needs.
• Manage and track multiple customer requests, issues, and project plans simultaneously.
• Develop and communicate project dependencies, milestones, and action plans.
• Support continuous quality improvement by evaluating processes, programs, and services and identifying opportunities for improvement.

Cross-Functional Collaboration and Communication

• Collaborate with Operations, Product, Analytics, and Engineering teams to support successful customer outcomes.
• Participate regularly in departmental and organizational meetings.
• Communicate major milestones, customer risks, project progress, and key outcomes to internal stakeholders.
• Conduct business reviews and prepare executive summaries and other customer or internal-facing communications.
• Present information to senior leadership and C-suite audiences when required.
• Build effective relationships with customers, internal stakeholders, employees, and peers to support organizational and customer goals.

Regulatory and Healthcare Expertise

• Maintain in-depth knowledge of CMS regulatory requirements relevant to the healthcare solutions and services being delivered.
• Apply healthcare risk adjustment knowledge to customer programs and project execution.
• Support customers involved in HHS RADV Initial Validation Audit programs.
• Use healthcare, regulatory, and operational expertise to help customers navigate complex requirements and achieve successful outcomes.

Qualifications

• Bachelor’s degree preferred, or equivalent work experience.
• 5+ years of experience working within a health plan, in a customer-facing vendor management role, managing Risk Adjustment or RADV lines of business, or in another relevant healthcare environment.
• At least 2 years of account management experience specifically involving HHS RADV Initial Validation Audit.
• Significant experience presenting detailed reports, gap-closing plans, and project plan dependencies to senior-level customer contacts.
• Strong project management skills with demonstrated ability to manage and track multiple customer requests, issues, and project plans.
• Experience managing customer relationships and accounts involving technically complex products or platforms.
• Strong analytical skills with the ability to interpret data, identify trends, recognize risks, and evaluate key performance indicators.
• Excellent written and verbal communication skills.
• Ability to communicate clearly, listen effectively, respond to questions, and adapt communication style to different audiences.
• Strong relationship-building and interpersonal skills.
• Ability to work effectively with diverse groups of customers and internal stakeholders.
• Strong customer focus, including the ability to understand customer perspectives, assess customer needs, and develop partnerships that improve satisfaction and reduce risk.
• Strong problem-solving skills and the ability to lead issue resolution toward mutually successful outcomes.
• Ability to evaluate policies, programs, and services and implement strategies that support continuous quality improvement.
• Ability to remain professional, calm, tactful, and effective in high-pressure situations.
• Adaptability and the ability to adjust methods in response to changing priorities, delays, or unexpected events.
• Self-motivated team player with strong organizational, presentation, and communication skills.
• Track record of performing successfully in agile, SaaS-based environments.
• Proficiency with Microsoft Office.
• Advanced proficiency in Microsoft Excel.
• Ability to build strong relationships, remain flexible and open-minded, accept feedback, and help motivate employees and peers toward organizational goals.
• Awareness of cultural differences and the ability to build effective relationships across teams, departments, and customer groups.

Benefits

• Medical insurance.
• Dental insurance.
• Vision insurance.
• 401(k) matching.
• Generous paid time off.