Highmark Health

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

Actuary

• 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

Manager

• 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.

Senior Data Engineer

Financial Planning and Analysis

• Lead a team of financial analysts responsible for providing critical financial insights and support to various Institutes
• Analyze monthly financial results, monitor key metrics for performance management, budget management, and special project support
• Perform management responsibilities to include hiring and termination decisions, coaching and development, rewards and recognition
• Communicate effectively within the team, amongst peers, and upwards to senior leadership
• Oversee the review and analysis of monthly financial results for various products, identifying variances from performance plans
• Develop and present clear, concise, and actionable reports to stakeholders
• Conduct ad-hoc analyses and provide recommendations to support decision making
• Support the annual budget process
• Team management and development: manage and mentor the team, provide technical guidance, training, and performance feedback

Manager, Finance

Vice President

• Guide a high-performing team of actuarial and analytics professionals
• Drive strategic, tactical, and operational excellence in claims reserving
• Serve as a trusted advisor to Senior Management and cross-functional teams
• Lead the comprehensive financial forecasting process
• Provide expert consultative services

VP Reserving Forecasting – Trend

Security Engineer

• Secures AI/ML, Generative AI, and agentic systems across the enterprise
• Designs, tests, and operates controls to protect systems at scale
• Advises engineering and security leadership on emerging AI threats
• Develops security controls for AI/ML, GenAI, and agentic systems
• Engineers guardrails to mitigate data leakage and insecure workflows
• Analyzes agent logic and identifies systemic security weaknesses
• Builds monitoring, logging, and alerting for AI systems
• Partners with AI platform and data engineering teams for security integration

Senior AI Security Engineer

• Participate in Highmark’s Actuarial Executive Development Program
• Develop efficient and transparent queries to obtain data
• Create studies, analyses, and presentation materials needed
• Proactively ensure internal and external consistency of all work

Senior Actuarial Analyst

Billing Specialist

• Communicate effectively to resolve discrepancies
• Process and maintain membership data
• Perform billing and accounts receivable activities
• Create and distribute membership materials

Enrollment and Billing Representative

Artificial Intelligence

• Collaborate with Sr. Consultant and business partners to identify AI opportunities.
• Work with technical teams to explore solutions to business problems through research and applying human centered design methods.
• Work across teams to facilitate the design of a proof of concept and testing plan.
• Ensure alignment around the problem statement and the measures that would determine whether the solution is viable.
• Support translating proof of concept into scaled use and value creation using change management and project management best practices.
• Serve as an advisor and partner for change execution.
• Work with the Sr. AI Consultant and business partners to create and groom portfolios of AI opportunities.
• Support reporting, ongoing prioritization, and facilitating value capture tactics.
• Other duties as assigned or requested.

Artificial Intelligence Consultant

Product Manager

• Development and product management of a service and or analytic product
• Primary point of contact to agile, large cross-functional teams
• Identify the product requirements for development
• Oversee priority, scope and the validation of work
• Collaborate with stakeholders to breakdown features into user stories
• Maintain a well groomed and prioritized backlog
• Recommend resolution paths to domain leadership
• Collaborate with external vendors to align roadmaps
• Track and provide status to leadership