Highmark Health

Actuary

• Responsible for the overall management and technical oversight of an actuarial staff
• Involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity
• Oversee the preparation of rate filings for large group, small group, direct pay, or senior products
• Work with Underwriting and Rating, Sales and Product Management and Development to develop and implement appropriate rating strategies
• Provide advanced support for the claim reserve process
• Ensure that all new products are financially viable and stable

Director, Actuarial Services

Project Manager

• Responsible for definition, planning and delivery of complex programs that require cross-functional collaboration
• Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects
• Work with business and technical organizations to assemble project teams
• Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program
• Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals
• Develop and maintain positive customer relationships

Cloud Engineer

• Advocate for cloud technology
• Analyze, design, code, test and implement technical solutions
• Collaborate with stakeholders to gather requirements
• Monitor work and provide updates
• Document technical processes and procedures
• Mentor associate and intermediate technical engineers
• Stay up-to-date with relevant technologies

Senior Cloud Engineer

Marketing

• Lead the advancement and maturity of the marketing technology stack and AI integration, ensuring it supports current and future marketing strategies and campaign needs
• Manage implementation of marketing technology roadmaps and ongoing platform support, including feature/function enrichment to meet current and future needs of marketing business users
• Serve as primary point of contact and owner for day-to-day vendor relationships, in partnership with many cross-functional areas
• Oversee the development and implementation of marketing operational strategies and plans
• Support budgeting, forecasting, and resource allocation processes for the marketing department
• Develop training and change management programs and services for marketing and experience team members

Marketing Technologist

Analyst

• Support definition, scoping, and prioritization of efforts for solution strategy
• Provide periodic reporting to leadership on assigned project activities
• Drive strong working relationships across matrixed teams and stakeholder groups

Senior Solution Analyst

Medical Billing and Coding

• Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. ( 65%)
• Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. ( 15%)
• Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. ( 10%)
• Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. ( 5%)
• Performs other duties as assigned or required. (5%)

Coder – Outpatient

Manager

• Implement care management review processes that are consistent with established industry and corporate standards
• Function in accordance with applicable state, federal laws and regulatory compliance
• Promote quality and efficiency in the delivery of care management services
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions

Care Manager, RN

Financial Planning and Analysis

• Support the monthly close cycle, rolling forecast, and executive reporting
• Own the financial narrative for enGen, including the monthly CFO close presentation
• Collaborate closely with the CFO and senior business leaders
• Advancing the team’s Power BI reporting capabilities and AI-driven automation initiatives
• Perform management responsibilities including hiring, coaching, and performance management

Manager – Financial Planning and Cost Analysis

Director

• Lead and mentor a team responsible for identifying and cultivating strategic relationships with providers in value-based arrangements
• Direct the administration of critical and timely communication to providers through various channels
• Perform management responsibilities to include hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity
• Collaborate closely with the Market Executive to lead the analysis and data-driven decision-making process
• Oversee the team's collaboration with actuary and informatics teams to develop impactful population health tools/reports

Director, Market Provider Engagement

• Develop comprehensive project plans
• Define and manage project scope
• Allocate and manage project resources
• Build and maintain strong relationships with key stakeholders
• Proactively identify, assess, and mitigate project risks and issues
• Prepare and deliver comprehensive project status reports
• Lead and motivate project teams
• Implement quality control measures to ensure projects meet defined quality standards

Client Project Manager, EMR Experience Required

Pharmacist

• Monitor FDA-approvals, drug manufacturer pipelines, and assess drug utilization reports
• Develop and execute the organization's drug formulary
• Develop pharmacy utilization management policies
• Maintain compliance with federal, state, and other mandates
• Write drug monographs for committee review
• Develop and implement management programs including prior authorization, dose and duration edits, quantity limits, step-care edits, and others
• Provide guidance to more junior team members
• Participate in evaluating, implementing, and monitoring pharmacy benefit-focused federal and state legislation
• Develop, execute, and monitor pharmacy-specific strategic initiatives
• Present recommendations to leadership

Senior Pharmacist – Strategy

Customer Support

• Engages with customers in a confident and compelling manner, performing the full range of customer service duties
• Strives to resolve customer concerns in a single interaction via telephone, written, or face to face communication
• Responds to a diverse set of customers with an equal level of confidence regardless of the issue at hand
• Works independently of support from a senior customer service representative, frequently utilizing the knowledge center
• Consistently exceeds results for internal adherence, efficiency, and inquiry timeliness.
• Resolves standard and frequently non-routine, limited impact, customer inquiries, comments, and concerns with the most limited escalation consistent with company policies and processes.

Customer Service Representative

• Define & diagnose a problem
• Outline data requirements for a study or analysis and devise potential solutions.
• Create studies, analyses, and presentation materials needed to appropriately inform decision makers.
• Make appropriate recommendations to management across teams within the actuarial department.

Associate Actuary

• Providing case mgmt in PA, DE and WV.
• Assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care.
• Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services.
• Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts.
• Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care.

Medical Case Manager

Data Engineer

• Design, develop, and maintain robust data processes and solutions to ensure the efficient movement and transformation of data across multiple systems
• Develop and maintain data models, databases, and data warehouses to support business intelligence and analytics needs
• Collaborate with stakeholders across IT, product, analytics, and business teams to gather requirements and provide data solutions that meet organizational needs
• Monitor work against production schedule, provide progress updates, and report any issues or technical difficulties to lead developers regularly
• Implement and manage data governance practices, ensuring data quality, integrity, and compliance with relevant regulations.
• Collaborate on the design and implementation of data security measures, including access controls, encryption, and data masking
• Mentor other associate and intermediate data engineers as needed
• Perform data analysis and provide insights to support decision-making across various departments
• Stay current with industry trends and emerging technologies in data engineering, recommending new tools and best practices as needed
• Other duties as assigned or requested.