Jobs at Highmark Health

Provide technical support, onboarding, lifecycle management, upgrades, integrations, migrations, and incident resolution for clinical applications and supporting infrastructure. Collaborate with clinical stakeholders, vendors, and IT teams to ensure reliable, secure, and compliant systems, assist with requirements, testing, documentation, and continuous improvement across clinical technology platforms.

Support Pharmacy Markets by leading projects, analyzing data, developing pharmacy benefit solutions, ensuring regulatory compliance, collaborating with stakeholders, and driving process improvements and KPIs to optimize member experience.

Lead multi-year strategy and roadmap for provider network products, translate market and business needs into requirements, manage product lifecycle from ideation to post-launch, partner with internal teams, track KPIs, represent product in governance, and mentor junior product team members.

Lead and deliver complex, cross-functional IT programs by assembling and managing matrixed teams, monitoring program financial health, assessing and mitigating risks, managing vendors and procurement as needed, and reporting progress to executive sponsors to ensure projects meet scope, quality, schedule, and budget targets.

Design, architect, and implement scalable, highly available software across digital channels. Participate in agile ceremonies, write and review code, create engineering specifications and user stories, mentor junior engineers, and drive technical execution and system architecture decisions using modern languages and cloud platforms.

Lead planning, execution, and delivery of mid-to-large projects: define scope, manage resources, risks, schedules and budgets, communicate with stakeholders, maintain documentation and quality, and lead project teams to successful on-time delivery.

Lead a team in actuarial work, financial forecasting, and trend analytics to support Highmark's strategic direction and compliance in the healthcare industry.

Support Product & Health Experience strategy execution by defining and improving PdMLC standards, stage gates, and workflows; build outcome-based metrics, support portfolio planning and resourcing analysis; maintain dashboards, internal communications, and forums; coordinate All-Hands and change management for AI integration; lead or participate in strategy projects and provide guidance to stakeholders.

Lead actuarial studies and analyses using actuarial and statistical techniques for pricing, reserving, claims trends, profitability, predictive modeling, and wellness studies. Define problems, outline data needs, produce recommendations, present to management, mentor junior staff, ensure quality and consistency, and implement process improvements across cross-functional teams.

Lead and deliver transformation engagements including capability and operating model design, process transformation, organization/job design, governance, business case development, and metrics. Perform quantitative analysis, present recommendations, facilitate workshops, manage workstreams, influence stakeholders in matrixed environments, and support team development and internal initiatives.

The Pharmacy Benefit Consultant offers strategic insights and consultation to clients, driving growth and retention in pharmacy solutions while focusing on business development, data analysis, and training.

Perform HCC and ICD-10 coding for Medicare Advantage, ACA, and ESRD risk adjustment projects. Review physician documentation, support RADV and regulatory audits, and collaborate with providers and internal partners to improve documentation, coding accuracy, and processes. Participate in education and project work to meet productivity and CMS compliance.

The Senior Stop Loss Claims Analyst evaluates and processes Stop Loss claims, assists clients, ensures compliance, and monitors claim submissions.

The Complex Case Manager RN manages a panel of members, assessing health needs, creating care plans, and coordinating resources for improved health outcomes.

The Complex Case Manager RN oversees and manages a panel of members' health needs, creates care plans, coordinates care, and ensures quality outcomes.

Support and analyze a specific business application set: gather requirements, propose solutions, create deliverables, participate in full project lifecycle, support testing and defect management, run/analyze reports, ensure compliance, and mentor junior staff.

The Manager Decision Support Analytics oversees department operations, manages data analysis projects, and aligns reporting with clinical goals. This role includes developing dashboards and maintaining data integrity while leading a team in a healthcare environment.

Lead as a Principal Data Architect in a complex hybrid ecosystem, focusing on data movement, enrichment, and orchestration while promoting best practices and innovation across the organization.

The Senior Accountant manages financial transactions, prepares financial statements and reports, provides analysis, and mentors junior staff while undertaking various accounting tasks.

Manage the reliability and performance of healthcare IT systems, ensuring efficient operations through collaboration with cross-functional teams, monitoring metrics, and mitigating potential disruptions.