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Company :

Highmark Inc.

Job Description :

Summary

The Government Business SVP will have overall enterprise-wide leadership, strategy, growth, and profit/loss responsibility for Highmark Health’s Government Segments. This includes the following lines of business: Medicaid, Federal Segments – Individual, ACA and Senior Markets, Group and Direct Pay Medicare Advantage, Direct Pay Medicare Supplemental and Prescription Drug Plan across all regional markets that Highmark serves. This includes the development and execution of the vision, strategic objectives, initiatives, and critical success factors that support Highmark Health’s corporate objectives covering Highmark Health’s multi-state Government lines of business and dual eligible portfolio. The successful candidate will provide vision and overall direction around the Government Business strategy, operations, and profitability; and will have primary accountability for continued growth and delivering new capabilities in Highmark Health’s current regional markets, as well as new markets. The Government Business SVP will work across Highmark Health’s enterprise to grow market share in existing programs, drive RFP processes for new business in Highmark Health’s existing regional markets and beyond and have accountability for defining and managing an operating model that is supportive of local market needs, while optimizing efficiencies to be gained. The incumbent is accountable to ensure effectiveness of the product portfolios in multiple geographic regions, partnering closely with Market Executives to develop provider partner strategies and provide leadership and vision in the product development and design of all related lines of business.

ESSENTIAL RESPONSIBILITIES

+ **Talent Management & Leadership Development** : Attract, develop, and retain a high-performing leadership team and talent base within the Government Segment. Foster a culture of accountability, innovation, collaboration, and employee engagement, setting the tone for company morale and ensuring succession planning.

+ **Strategic Leadership & P&L Accountability:** Provide executive leadership and strategic direction for Highmark's Government Segment, ensuring alignment with the organization's overall mission, vision, and financial objectives. This includes owning full profit and loss (P&L) accountability for the segment, directly leveraging and leading the C2V (Cost to Value) strategy to drive consistent growth, optimize financial performance, and achieve profitability targets.

+ **Financial Management & Performance** : Drive rigorous financial planning, budgeting, forecasting, and performance analysis for the segment. Implement effective cost management strategies while ensuring appropriate resource allocation to achieve financial objectives.

+ **Market Development & Margin Improvement:** Develop and execute comprehensive market development strategies, including annual market plans, to achieve membership, revenue, and quality targets within the government segment. Optimize operational efficiencies and pricing strategies to enhance margin performance and effectively manage competitive pressures.

+ **Product Strategy & Innovation** : Lead the development, execution, and continuous optimization of the Government Segment's product portfolio. Drive segment specific product innovation, informed by deep market understanding, competitive intelligence, and consumer insights, to develop solutions-oriented products and capabilities that enhance market position, achieve desired financial performance, and improve member experience.

+ **Quality & Risk Management** : Strategically develop STARS/Quality and Risk Adjustment initiatives across the Government Business segment, driving measurable improvements in member health outcomes, optimizing Stars ratings, and ensuring the accuracy and completeness of risk adjustment data to maximize revenue and resource allocation.

+ **Cross-Functional Collaboration** : Serve as a pivotal executive leader within Highmark, actively driving and ensuring effective collaboration with senior leaders across all matrixed organizations and corporate functions throughout the enterprise. This critical leadership establishes integrated strategies, enables seamless execution of initiatives, and optimizes alignment to achieve Highmark's overarching goals.

+ **External Stakeholder Management** : Cultivate and maintain strategic relationships with key external stakeholders, including government agencies (federal and state), regulatory bodies, industry associations, providers, community organizations, and advocacy groups. These relationships will help to advance the segment and markets strategic positioning, interests, and influence policy.

+ **Sales & Distribution Channel Management** : Develop and oversee robust sales and distribution strategies for the government segment, encompassing direct-to-consumer channels, broker/consultant networks, FMOs, and other partnerships, to achieve sales goals and optimize market reach.

+ **Regulatory & Compliance Oversight** : Serve as the primary executive responsible for ensuring all segment operations, products, and strategies are in full compliance with complex legislative, regulatory, and contractual requirements specific to government healthcare programs (e.g., CMS, state Medicaid agencies). Partner closely with Legal and Compliance to proactively address emerging issues and maintain a robust compliance framework.

QUALIFICATIONS

Required

+ Bachelor’s degree

+ 15 years of health care management leadership with full P&L accountabilities

+ 7 years of Government Markets Segment Experience

+ 10years of experience in health insurance senior management

Preferred

+ Master's Degree

+ 10 years of experience in Medicare/Medicaid

+ 10 years of experience in Sales & Marketing

SKILLS

+ Strong executive leadership and management skills across a matrixed organization

+ Strategy development and execution

+ Strong P&L financial acumen and ability to draw appropriate insights

+ Government-regulated business and compliance knowledge

+ Comprehensive and balanced knowledge of overall healthcare industry, insurance administration, product marketing, strategic

+ planning, financial management, clinical services, provider and member service, provider reimbursement, and operations.

+ Demonstrated visionary leadership including a record of accomplishments in driving the profitable growth of a health plan.

+ Working in a highly matrixed managed care environment, familiarization with state and national health care delivery systems.

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._

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.

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For accommodation requests, please contact HR Services Online at [email protected]

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Req ID: J274333