Highmark Health

Consultant

• Acts as a core care team member to develop specific clinical pathways or best practice programs for targeted patient groups
• Participates in practice staff meetings and trainings
• Provides education and support on a variety of topics from behavioral health and substance abuse background, training, and expertise to multidisciplinary team members during the course of treatment planning for patients
• Participates in daily huddles, listening for behavioral health, substance abuse, and psychosocial needs
• Provides population based care based on registry to high risk/high need patients
• Provides services to all enrollees (not just those with diagnosable mental disorders)
• Advocates for patients who are perceived as difficult to work with or “non-compliant”
• Engages patients via telephone as well as in person

Behavioral Health Consultant

Recruitment

• Assists in providing adequate, competent staff for each of the locations, by working closely with the Managers to identify their staffing needs.
• Coordinates and adjusts schedules on a daily basis; also reviews schedules for monthly projections.
• Looks and plans proactively for staffing needs created by vacancies and Leaves of Absences.
• Maintains statistical information.
• Maintains workflow in accordance to staffing pattern and/or per request of nurse directors.
• May handle appropriate orientation of agency/external staff, ensuring their orientation/training meets DOH and JCAHO guidelines; maintains appropriate files for agency/external staff.
• Demonstrates effective communication skills with patients, families, physicians and other healthcare team members as they enter or contact the nursing office.
• Under the direction of the Director or Manager, may act as the liaison with external staffing agencies.
• Performs other duties as assigned or required.

Coordinator – Clinical Staffing, Anesthesia Institute

Claims Specialist

• Review, evaluate, and process various Stop Loss claims in accordance with established standards
• Build positive client relationships and provide education
• Analyze client claim losses and current issues
• Follow up on pended claims as per department standards
• Process daily incoming Stop Loss claims
• Evaluate claims for compliance with policy provisions and regulatory guidelines
• Monitor and analyze complex claims and control losses through managed care
• Finalize and adjudicate claims up to a pre-determined dollar threshold
• Complete pended claim letters to TPAs or brokers
• Identify discrepancies in claims submissions

Senior Stop Loss Claims Analyst

Manager

• Define, own, and deliver mid-size engagements to meet/exceed key performance metrics
• Manage 1-2 simultaneous client engagements
• Lead individuals, teams or multiple groups
• Plan, organize, and manage all phases of a project lifecycle
• Conduct detailed discovery meetings and collect requirements
• Help with performance management, coaching, and targeted individual development activities

Transformation Manager

Security Engineer

• Manage Information Security and Risk Management services with a focus on the Vulnerability Management program
• Scale vulnerability management capabilities including detection strategies and metrics
• Lead security staff and embed vulnerability management into IT operations
• Active contributor to ISRM strategic planning

Manager, Information Security and Risk Management – Vulnerability Management

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
• Mentor other associate and intermediate data engineers as needed

Senior Data Engineer – Streaming, Analytics, Visualization

Analyst

• Review inquiries to determine if they meet definition of appeal/grievance.
• Request and review all related relevant documentation and assemble case file.
• Coordinate resolution results and relay investigative results with all involved parties.
• Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends.
• May support the Quality Assurance, Appeal and other quality committees.
• Other duties as assigned or requested.

Senior Appeals Analyst

• Screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims.
• Determines whether to return, deny or pay claims following organizational policies and procedures.
• Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary.
• Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes.

Senior Claims Processor

Customer Support

• Handle customer inquiries by telephone, email, or in-person
• Troubleshoot and resolve customer complaints
• Maintain accurate records, including timekeeping records
• Attend required training classes

Associate Customer Service Representative

Director

• Lead the strategic development and delivery of comprehensive reporting packages
• Establish a single source of truth for KPIs and operational insights
• Collaborate with clinical, operational, and administrative stakeholders to validate data accuracy

Director, Physician Organization Operational Analytics

• Provides support to senior analysts in building hospital, professional, and ASC contracts in Epic.
• Manages underpayment AR for assigned payors including successfully recovering on underpaid accounts.
• Collaborates with Revenue Cycle and Finance Teams on contract building and analysis requests.
• Provides assistance in performing analyses to support reimbursement impact analysis.
• Perform other duties as assigned or required.

Associate Managed Care Analyst

Business Intelligence Analyst

• This job provides strategic leadership and tactical direction working collaboratively with stakeholders from the organization's clinical, financial, and information technology functions.
• Responsible for the development, implementation, and optimization of a business intelligence strategy and plan focused on Business Intelligence, Data Warehouse, and Reporting technologies.
• Work closely with stakeholders at all levels to identify and prioritize ongoing technology and process improvements.
• Lead and develop a high-performing BI team, recruiting, mentoring, and fostering expertise in healthcare data analytics.
• Define, champion, and execute a comprehensive Business Intelligence roadmap aligned with strategic goals for patient care, operational efficiency, quality outcomes, and financial performance.
• Establish and enforce enterprise-wide data governance policies, quality standards, and privacy frameworks ensuring accuracy and adherence to HIPAA regulations.
• Oversee design, development, and performance optimization of data infrastructure, ensuring robust integration and security of data sources.
• Champion data literacy and effective utilization of BI tools across various departments, demonstrating value through comprehensive data analysis.
• Provide expert technical leadership in BI development, guiding the team in leveraging complex healthcare data models for actionable insights and reporting.

Director, Business Intelligence

• Leading and developing a team of Business Relationship Managers who serve as the primary liaison between business stakeholders and IT.
• Ensuring consistent delivery of high-quality engagement, prioritization, and outcomes across portfolios by setting direction, balancing demand, and aligning work to organizational strategy.
• Providing coaching, performance management, and escalation support, while also partnering with senior leaders to translate business priorities into actionable, value-driven initiatives.
• Accountable for team effectiveness, stakeholder satisfaction, and continuous improvement of business-IT collaboration practices.

Manager, IT Business Relationship Management

General Counsel

• Provide regular legal support for one or more discrete units of the Corporation
• Interpret law and apply to internal / external business issues and recommend best practices
• Provide timely, accurate, comprehensive, thorough and practical legal advice
• Manage litigation, transactions or other matters and/or assist and work cooperatively with and/or supervise outside legal counsel

Senior Counsel – Privacy

Content Writer

• Develop, plan, research, write, edit, manage, and deliver complex request for proposals and information.
• Conduct market research, trend analysis to interpret and understand the needs of the customer.
• Tailor product information and positioning to customize various sales strategies