Risk Solution Director

The Risk Solutions Director is the company’s authoritative expert on clinical or program domains and is accountable for how that domain performs across the entire solution portfolio. This role focuses on the domain of Risk Adjustment across all lines of business.

The Risk Solution Director operates as a deep specialist across all segments and lines of business. This is not an SME support or technical advisory role. The Risk Solutions Director owns outcomes: domain-level product-market fit, the strength of the value narrative, and the clinical or programmatic integrity of what the company sells and delivers. It requires equal parts domain command, commercial orientation, and cross-functional influence.

Domain Strategy & Portfolio Authority

Drive the domain roadmap. Maintain a current, prioritized view of where the domain needs to go - capabilities, depth, competitive differentiation - and translate that into actionable product input.

Define what “good” looks like. Establish outcome standards, solution design principles, and minimum viable configurations for the domain

Identify and close portfolio gaps. Quantify capability shortfalls that limit commercial performance, build the investment case with ROI rationale, and drive prioritization decisions with leadership.

Own discovery, prioritization and scoping on customer feedback and requests provided via intake process, identifying thematic improvements and actioning on key requests within the domain – both customer-specific and global.

Cross-Segment Solution Design

Run domain-level pilots and validation. Lead incubation of new domain capabilities or modules, including design of the test, success criteria, and decision framework for productization.

Maintain cross-segment consistency. Ensure that domain solutions deployed across segments do not fragment into one-offs. Standardization of the domain layer is your accountability.

Market & Competitive Intelligence

Own the domain value narrative. Develop and maintain the authoritative story for the domain: buyer-ready proof points and competitive differentiation.

Own domain-level market intelligence. Track regulatory developments (e.g., ONC/CMS rule changes, CMMI program evolution), competitive moves, and buyer expectation shifts within your domain. Synthesize signal from noise and surface forward-looking implications, not just observations.

Cross-Functional Leadership

Influence without authority. Drive alignment across Product & Technology, Sales, Customer Success, and Services on domain-related decisions. Earn trust through clarity and credibility.

Support growth objectives as needed as a subject matter expert with domain knowledge.

Requirements

• 5+ years in healthcare SaaS, clinical services, or health plan operations, with deep expertise in Risk Adjustment.
• Direct experience at a healthcare SaaS company in a product, solutions, or strategy role with domain accountability.
• Demonstrated ownership of a domain-level strategy or product area with measurable outcomes
• Commercial orientation and experience: has operated in or closely adjacent to revenue-generating functions. Understands how the domain translates to buyer ROI and can build a value narratives independently
• Preferred Skills & Experience: Regulatory depth: has tracked and responded to CMS rulemaking or CMMI program evolution in real time.
• Experience building or evaluating domain-specific content assets, workflows, or analytics that are embedded in customer operations at scale.
• Familiarity with both sides of the payer–provider relationship in the context of the target domain - understands how incentives and accountability are distributed across the ecosystem.
• Cross-functional influence: can name the mechanisms used to drive alignment across Product, Sales, and CS without direct authority
• Analytical discipline: defines the right domain-level metrics, tracks them, and uses data to drive investment and prioritization decisions
• Executive communication: precise and credible with VP and C-suite audiences, both internal and customer-facing.
• Competencies: Business Insight & Organizational Savvy
• Aligns tasks and initiatives with company priorities, translating goals into actionable plans with clear milestones.
• Navigates organizational dynamics effectively, engaging key stakeholders and leveraging resources to develop strategic solutions.
• Regularly evaluates and adjusts priorities to ensure meaningful impact and results.
• Manages Ambiguity & Complexity
• Navigates uncertainty and change with flexibility, making decisions despite incomplete information.
• Collaborates to find solutions, manages risk, and remains productive in ambiguous situations, viewing complexity as an opportunity
• Plans and Aligns, Resourcefulness
• Plans and prioritizes work to meet business goals, breaking objectives into actionable steps.
• Anticipates challenges, adjusts plans, and organizes resources for efficiency.
• Continuously adapts priorities and maintains focus on key milestones.
• Situational Adaptability & Flexibility
• Quickly adjusts approach to meet changing situations, demonstrating high versatility and adaptability.
• Focuses on making a positive impact in every interaction and remains positive when quick pivots are needed, seamlessly fitting into any environment.
• Strategic Mindset
• Anticipates future trends and potential roadblocks, creating strategies to drive results.