Highmark Inc.
JOB SUMMARY
***This is a hybrid role, and will require you to be onsite at our Pittsburgh, PA Location 3 days a week (Tuesdays, Wednesdays, & Thursdays).
Job Summary
This is a hybrid role requiring onsite presence three days per week. Pittsburgh, PA is the preferred location; however, other locations may be considered.
This position partners closely with contracting, provider reimbursement, actuarial, and senior leadership to develop and deliver advanced analytics that directly inform and support contract negotiation strategy, unit cost management, and key business decisions. The role is responsible for independently building and interpreting complex financial and utilization models, translating data into actionable insights, and evaluating the impact of reimbursement structures across provider arrangements. Additionally, this role will proactively identify cost drivers, assess financial risk, and develop scenario-based analyses to guide strategic direction.
The successful candidate will possess a strong understanding of healthcare reimbursement methodologies (e.g., DRGs, APCs, RVUs, case rates, and episodic payment models) and payer policies, including familiarity with Medicare and Medicaid. This role requires advanced analytical and problem-solving skills, with the ability to synthesize large, complex datasets and clearly communicate insights and recommendations to both technical and non-technical audiences.
ESSENTIAL RESPONSIBILITIES
- Develop and foster internal relationships across the corporation. Provide analytic and consultative support to a broad spectrum of internal customer areas and external business partners.
- Mentor colleagues with less experience on both the technical and business aspects of project and consultative work.
- Determine how decision support systems will provide information required to make effective business decisions, translate requirements into applications that employ appropriate decision support and reporting tools. Use broad experience and technical knowledge to propose solutions to complex business problems. Take the lead in driving the implementation of the recommended solutions.
- Take the lead in defining issues and ideas to be studied as well as the approach (methodological and technical) to be used in addressing studies and projects. Create and/or develop new methods of analysis, database design, and performance measurement or, in some cases, adaptation of existing solutions to new areas.
- Perform modeling of data sources and flows, work with data management staff to define an operational framework that will define, develop, and implement policies and security frameworks to ensure precise and secure deliver of knowledge and information.
- Provide assistance and, depending on skill and experience, lead with interpretation of raw data, statistical results or otherwise compiled information, identify follow-up action items, and prepare or assist in the preparation of written reports and/or oral presentation of findings to internal and external audiences, customer managers, clinical staff, compliance agencies, group accounts, providers, agent plans, and brokers.
- Develop and maintain moderate-to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL) and other database technology (DB2, Teradata, and Oracle).
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering or Operations Research, or related field
Substitutions
Preferred
- Master's degree in or related to Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering or Operations Research
EXPERIENCE
Required
- 5 years of relevant, progressive experience as a Decision Support Analyst or equivalent training and experience in a business or clinical environment with direct responsibility for applying technology
Preferred
SKILLS
- Strong technical skills in the mainframe, PC and Internet-based technologies to be effective and must be comfortable and proficient using large and complex databases
- Strong skills using various third-party office and report generation products such as Microsoft Office, Business Objects, Cognos, and Enterprise Guide.
- Strong communication skills. Must be comfortable presenting findings and offering recommendations to senior management
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Never
Travel regularly from the office to various work sites or from site-to-site
Never
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Never
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 traini
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
