Highmark Health

Full-stack Engineer

• Build complex and scalable application integrations for HR/Payroll solutions across various digital channels
• Participate in all aspects of integration build: idea generation, business analysis, technical design, and integration development using Workday proprietary tools
• Design and create engineering specifications; write code adhering to coding standards and perform code reviews
• Monitor technical process against project plans, safeguard functionality, scalability and performance
• Participate in agile ceremonies, assist in sprint planning, create stories/tasks, update status, and communicate blockers
• Mentor associate software engineers and perform other duties as assigned
• Comply with HIPAA, data security guidelines, and company Code of Business Conduct

Software Engineer, Workday Integrations

Data Scientist

• Work directly with the business to understand processes and aims, then identify analytical solutions; outline complex new use cases and impact estimates
• Assemble data sets using Highmark operational and analytic data structures; deliver analytical solutions to multiple complex business problems
• Select and apply appropriate advanced modeling techniques; ensure final analysis is well researched, accurate, and documented
• Translate results into actionable business insights via written reports, presentations, and data visualizations; link results to business objectives
• Plan, prepare and deliver analyses largely independently on time and production-ready; determine best route to deployment
• Lead major projects within ED&A; mentor/teach others; engage with external collaborations
• Publish seminal findings; contribute to graph intelligence leadership in healthcare

Lead Data Scientist – Research and Development, Graph Intelligence

Engineer

• Support design, development, and maintenance of technical solutions across infrastructure, systems, networks, applications, integrations
• Analyze, design, code, test and implement technical solutions; provide production monitoring and support
• Collaborate with stakeholders across IT, product, analytics, and business teams to gather requirements and deliver solutions
• Monitor production schedules, report progress and issues to leadership
• Document technical processes and participate in technical reviews and knowledge sharing
• Collaborate on design and implementation with architecture to ensure enterprise alignment
• Perform technical analysis to support cross-department decision-making
• Stay up-to-date with relevant technologies and industry best practices
• Other duties as assigned

Technical Engineer

QA Engineer

• JOB SUMMARY This job has oversight responsibility for all risk & quality assurance studies required by regulators, the Blue Cross Blue Shield Association (BCBSA), accreditation bodies, executive management, plan partners, group customers, and employee level performance.
• ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Manages global team responsible for accreditation and quality assurance across the enterprise. Responsible for managing and controlling (a) the BCBSA's Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program Quality Program, (b) the National Committee for Quality Assurance (NCQA) compliance, (c) Joint Commission accreditation compliance, (d) quality measures required by state regulators, (e) certain quality measures related to group and partner plan contractual performance guarantees / service level agreements, and (f) employee performance quality. Interacts with internal and external personnel at all levels and effectively communicate risks, expectations, and alternative strategies to mitigate concerns over operational performance and program compliance. Actively collaborates and presents with Risk Partner and Business Unit executives in customer and regulator meetings (Insurance Department, HHS/CMS, Department of Health) on key risk and compliance related activities, issues, and remediation, promoting effective relationships. Manages teams conducting internal mock audits to ensure continuous audit preparedness, identifying opportunities for improvement and actions required, communicating results to business owners, and reporting results to management. Other duties as assigned or requested.

Manager Risk & Quality Assurance

Manager

• JOB SUMMARY This job assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care.\n• Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services.\n• Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts.\n• 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.\n• Facilitates and/or participates in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members.\n• ESSENTIAL RESPONSIBILITIES\n• Communicate effectively while performing customer telephonic interviewing and communication with external contacts.\n• Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.\n• Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States\n• Educate members to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes.\n• Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care.\n• Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.\n• Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member.\n• Develop an individualized plan of care designed to meet the specific needs of each member.\n• Anticipate the needs of members by continually assessing and monitoring the members progress toward goals, care plan status, and re-adjust goals when indicated.\n• Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.\n• Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention to develop a realistic plan of care.\n• Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination.\n• Maintain a working knowledge of available community resources available to assist members.\n• Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible.\n• Work within a Team Environment.\n• Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services to enhance professional knowledge and competency for overall management of members.\n• Participate in departmental and/or organizational work and quality initiative teams.\n• Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.\n• Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources.\n• Foster effective work relationships through conflict resolution and constructive feedback skills.\n• Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable.\n• Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served to foster constructive and collaborative solutions to meet member needs.\n• Other duties as assigned or requested.\n• QUALIFICATIONS Minimum Bachelors degree in nursing or RN certification in lieu of bachelors degree or Masters degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations. OR Bachelors degree in Social Work with five years experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.\n• Bilingual English/Spanish language skills.\n• Case Management Certification\n\nLICENSES AND CERTIFICATIONS\nRequired Licensed Social Worker (LSW)-Non-Specific - State (OR)\nRegistered Nurse - Non-Specific (OR)\nLicensed Professional Counselor (LPC)  Non-Specific State ( OR )\nLicensed Bachelors Social Worker (LBSW).\nIncumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 6/30/2026.\nL icense in WV is required.\nPreferred None\nSkills None\nSCOPE OF RESPONSIBILITY\nDoes this role supervise/manage other employees? No\nWORK ENVIRONMENT\nIs Travel Required? No\nDisclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.\nCompliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $57,700.00 Pay Range Maximum: $107,800.00 Base pay is determined by a variety of factors including a candidates qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice About Us Highmark Health is a national, blended health organization that includes one of Americas largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Healths 35,000 employees serve millions of customers nationwide through the nonprofit organizations affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Healths businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Read More Follow Us © 2025 Workday, Inc. All rights reserved.

Software Engineer, Workday Integrations

Lead Data Scientist – Research and Development, Graph Intelligence

Technical Engineer

Manager Risk & Quality Assurance

Medical Case Manager