Highmark Health

Full-stack Engineer

• Responsible for designing and creating engineering specifications for software applications and programs.
• Responsible for designing & writing code that adheres to coding standards.
• Performs code reviews.
• Responsible for idea generation, exploring and implementing appropriate technical solutions to achieve the required product features, as well as monitoring technical process against project plan while safeguarding functionality, scalability and performance.
• A part of an agile work team and responsible for participating in all scrum ceremonies, assisting in sprint planning and completing required sprints in the development through final execution of software applications/programs.
• Communicate any issues/blockers to the Scrum Master in a timely manner.
• Drive story creation (i.e. DoD, Acceptance Criteria, estimation).
• Create Tasks for their stories in applicable software (ex: RTC or Jira), and updates status and assignment accordingly.
• Monitor work against production schedule and provide progress updates and report any issues or technical difficulties to lead developers on a regular basis.
• Mentor other associate and intermediate software engineers as needed.
• Other duties as assigned or requested.

Senior Software Engineer

Architect

• Develop and maintain business process flows, value stream maps, and reference architectures for complex processes across multiple product areas
• Create conceptual models demonstrating how people, process and technology interoperate within the organization
• Partner with Business Leads to develop and maintain capability roadmaps informed by industry research and business strategy
• Monitor industry architecture trends and determine the benefits of modifying or expanding the framework
• Operational implementation and adoption of new business processes

Lead Business Architect

Systems Engineer

• Work with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions.
• Create and maintain deliverables such as business vision, requirements and personalization to different clients, and user interface design.
• Participate in the full software development life cycle by actively participating on Agile scrum teams in various roles, including, but not limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager, or Tester, based upon experience and need.
• Support various aspects of requirements testing (e.g. testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts.
• Ensure compliance for required standards and all necessary approvals have been obtained throughout the project lifecycle.
• Effectively communicate with team members, customers, partners and management, including assisting with or conducting requirement walkthroughs and sprint reviews, reporting project status, enabling vendor solutions and providing accurate and concise documentation.

Business Systems Analyst

Manager

• Assess health management needs of assigned member panel
• Utilize data/analytics and clinical judgment to identify right interventions
• Create care plans and manage case load of members
• Conduct outreach to members for care coordination
• Monitor and improve quality outcomes for members

Complex Case Manager, RN

Director

• Responsible for the successful implementation of the AHN enterprise-wide quality and patient safety goals
• Oversees the quality and patient safety functions while working in tandem with the QSV division
• Accountable for driving results to achieve top performance for all clinical, pay for value and patient safety outcomes
• Perform management responsibilities to include hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity
• Lead and/or facilitate internal quality and patient safety initiatives to achieve successful outcomes and minimize harm to patients and staff

Director Quality, Patient Safety

Project Manager

• Develop comprehensive project plans, including detailed schedules and resource allocation
• Build and maintain strong relationships with key stakeholders
• Proactively identify and mitigate potential project roadblocks
• Prepare and deliver comprehensive project status reports
• Lead and motivate project teams and foster a collaborative work environment

Client Project Manager

Product Manager

• Develops the product vision and creates comprehensive execution plans
• Secures alignment from key stakeholders for product's lifecycle from conception to delivery
• Actively engages with the Delivery team during sprint and milestone reviews

Product Manager – Utilization Management

AI Engineer

• Designing, developing, and deploying generative AI models (e.g., LLMs, diffusion models)
• Architecting and building agentic systems with autonomous decision-making capabilities
• Integrating generative AI and agentic solutions into existing products and services
• Developing and maintaining the software infrastructure required for AI/ML pipeline
• Developing and implementing data pipelines for training and evaluating AI models
• Conducting research and experimentation with new generative AI and agentic techniques
• Other duties as assigned or requested

Medical Director

• Conduct electronic review of escalated cases against medical policy criteria
• Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
• Compose clear and concise rationales for member and provider determination notifications
• Participate as a member of the CMDM multidisciplinary team
• Advise multidisciplinary team on cases that require physician expertise
• Actively manage projects and/or participate on project teams that require a physician subject matter expert

Account Executive

• This job is responsible for managing a book of business and the business relationship as a strategic consultant for existing accounts directly or through intermediaries.
• The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business.
• The incumbent is responsible for complex accounts that are multi-state and non-standard and complex, involving multiple, custom products and benefit designs.
• Manage and cultivate strategic relationships at senior levels with clients, consultants, and brokers/producers to foster valued business partnerships.
• Serve as the primary pharmacy client contact for strategic planning, consultation, and ongoing account management, overseeing a book of business for complex, multi-state, and non-standard accounts.
• Proactively engage clients to understand evolving needs, business plans, and financial objectives, driving client retention and satisfaction by ensuring continuous alignment with Highmark’s pharmacy benefit solutions.
• Review and present new products, services, capabilities, and technologies to sell assigned product lines, secure pharmacy renewals, and achieve add-on sales to ensure retention, profitability, and growth of existing business.
• Analyze customer needs and organizational financial objectives to recommend appropriate pharmacy benefit products and services, including formulary management, clinical programs, specialty pharmacy, and network management.
• Develop, implement, and execute comprehensive business plans and metrics for retaining and growing membership while enhancing profitability and cross-selling.
• Complete and maintain accurate sales projections.
• Coordinate all post-sale and ongoing operational aspects of the company's services, communicating effectively with senior-level client executives.
• Support customers during the implementation of sales contracts and throughout the relationship by advocating for and resolving escalated pharmacy service issues in a timely and professional manner.

Pharmacy Strategic Account Executive

• Collaborates with Executive Leadership to define, plan, and deliver complex programs that require cross-functional coordination and management of several business leaders within the health system.
• Programs, projects, or related activities may be interdependent and should be developed within the constraints of scope, quality, time, and budget.
• Directs and delegates the efforts of a group of employees and contractors that serve on the program to deliver results for the organization.
• Works with business and technical organizations within the health system to determine program strategy and approach.
• Organizes, plans, and maintains program roadmap consisting of cross-functional activities/projects.
• Leads project team in the development and maintenance of comprehensive plans for a defined program.
• Monitors, evaluates, and reports on program status inclusive of scope, schedule, budget, and alignment with program and strategic goals.
• Develops and maintains positive customer relationships.

Senior Project Manager

Support Engineer

• Provide critical sales account support for HM Insurance Groups' Stop Loss Business Unit
• Facilitate the seamless implementation and ongoing administration of group accounts
• Assist the sales team by managing complex, stop loss sales cycle tasks
• Act as a primary point of contact for resolving issues related to RFP intake, underwriting, account implementation, and ongoing group account service
• Contribute to and manage small to medium projects within their assigned area

Senior Account Support Analyst

Risk

• Lead in conducting information risk assessments as assigned to the team
• Request and analyze documentation necessary to perform appropriate assessment and conduct necessary interviews in order to collect and review relevant materials necessary to produce results of the assessment
• Clearly and concisely document and communicate risk assessment results with requester, security architects and management, as appropriate
• Conduct and formulate appropriate risk scoring, as it relates to threat, vulnerability, likelihood, impact, security controls/countermeasures, etc.
• Perform follow up activities related to assigned risks, ensuring mitigation activities stay on track
• Communicate risk treatment methodology, risk avoidance, risk acceptance, risk transference and risk mitigation to appropriate groups
• Take lead role in partnering with multiple projects and initiatives to apply security architecture requirements, develop architecture solutions, integrate security into solution designs, access risks of security gaps, and develop architecture remediation
• Prepare and present solution decks to different levels of management and varying technical experience

Senior Information Risk Consultant

Financial Planning and Analysis

• Conduct financial and business related research and analysis
• Develop and maintain spreadsheets and databases
• Perform financial and business related analysis
• Communicate with management at all levels

Lead Financial Analyst

Claims Specialist

• Receives and processes claims including entering/verifying claims data
• Resolves claim edits and determines benefit eligibility
• Reviews payment levels and elevates issues to supervision as necessary
• Meets production and quality standards, ensuring timely and accurate work
• Maintains accurate records including timekeeping
• Attends all required training classes