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Company :

Highmark Health

Job Description :

JOB SUMMARY

The incumbent works closely with internal customers responsible for the design and operations of enterprise value based reimbursement programs. Has an understanding of key provider reimbursement concepts and the ability to communicate those concepts effectively. Delivers analytics and insights to key decision-makers to help guide and design programs and initiatives. Through close collaboration with business stakeholders, works to create and maintain documentation supporting business processes as well as the development and submission of standard assets. Works with technical teams to understand technical workflows, develop and submit technical business requirements and validate data generated by recurring analytic engine processes. Performs data modeling and partners with data management staff to work efficiently and capitalize on data automation opportunities. Reports on value based reimbursement program outcomes, trends, and drivers to improve financial performance

ESSENTIAL RESPONSIBILITIES

+ Develops internal-facing provider reports/analytic tools to highlight key performance indicators for value based reimbursement programs and trend drivers of overall financial/quality performance.

+ Designs basic scorecards and dashboards using analytic tools to support value based reimbursement arrangements with large strategic partners in the market.

+ Supports the creation of value based reimbursement programs across the enterprise including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers.

+ Interprets raw claims, provider, quality, and member data to build data sets to be used for analytic and reporting purposes.

+ Assists with provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider.

+ Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect the financial position.

+ Interacts with stakeholders in a manner that fosters cooperation and teamwork while conveying engagement and competence. Provides responsive service and understands customer needs.

+ Other duties as assigned or requested

• **EXPERIENCE**

Required

+ Relevant analytic work experience

+ Insurance or healthcare work experience

​

Preferred

+ SQL and GCP

• **SKILLS**

+ Analytic Judgement

+ Effective Use of Technology

+ Efficient and Organized Work Habits

+ Strong Work Ethic & Standards

•​ **EDUCATION**

​

Required

+ Bachelors degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field or 6 years of relevant work experience in lieu of a Bachelor's Degree

Preferred

+ Masters degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field

LICENSES or CERTIFICATIONS

Required

+ None

Preferred

+ None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

**_Disclaimer:_** _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._

**_Compliance Requirement_** _: This job 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:

$50,200.00

Pay Range Maximum:

$91,200.00

_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 [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J267199