A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best.

Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia.

We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions.

Our financial position reflects strength and stability, with our year-end 2021 consolidated revenues totaling $22 billion.

We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

The incumbent works closely with internal customers responsible for enterprise value based reimbursement programs' strategy, design, and operations. The incumbent understands key provider reimbursement concepts and has the ability to communicate and present those concepts effectively. Delivers high-quality analytics and insights to key decision-makers to help guide and design programs and initiatives. Performs innovative data modeling and routinely partners with data management staff in order 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 and external facing provider reports/analytic tools to highlight key performance indicators for value based reimbursement programs and clearly define the significant trend drivers of overall financial/quality performance.
• Designs scorecards and dashboards using advanced analytic tools to support value based reimbursement arrangements with large strategic partners in the market. Understands how the reports are used by strategic partners.
• Supports the creation of value based reimbursement programs across the enterprise including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers. Understands how design of these programs creates financial value for the enterprise.
• Interprets raw claims, provider, quality, and member data to build data sets for analytic and reporting purposes. Executes transparent and repeatable processes to access data.
• Assists with provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider. Helps generate ideas for potential cost-saving initiatives.
• Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect financial position. Assesses potential risks and opportunities and clearly defines scenarios for achieving certain outcomes.
• Enhances department influence by providing responsive service and understanding customer needs. Effectively explains technical concepts to both technical and non-technical people.

EXPERIENCE

Required

• 3 years of Relevant analytic work experience

Preferred

• 3 years of Insurance or healthcare work experience

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

Travel Requirement:

0% - 25%