Decision Support Analyst - Medicaid Value Based Analytics

highmarkhealth; Pittsburgh (Allegheny County); On-site; USD 90,000 - 115,000; Full time

Job summary

Highmark Inc. is seeking an advanced analytics professional to support Medicaid value-based care and provider performance initiatives. You will analyze healthcare data, build dashboards, and develop models to drive quality and cost improvements.

Responsibilities include collaborating with cross-functional teams, mentoring peers, and translating findings into actionable insights for executives. The role requires strong analytical skills, problem solving, and the ability to manage complex projects

Qualifications

• Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, or related field or relevant experience.
• 3 years of relevant, progressive experience in Industrial Engineering or Operations Research.
• Experience using SQL to query and analyze large healthcare datasets.
• Experience developing dashboards and visualizations using Tableau.
• Experience working with healthcare claims, provider performance, quality, utilization, or value-based care data.
• Experience supporting provider-facing analytics and value-based reimbursement programs.

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.
• Lead in defining issues and approaches for studies and projects; develop new methods of analysis and data flows.
• Model data sources and flows; work with data management to define secure deliverables.

Skills

SQL

Tableau

Communication skills

Mainframe/DB knowledge

Education

Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, or related field

Tools

SAS

R

SQL

DB2

Teradata

Oracle

Job description

Company :

Highmark Inc.

Job Summary :

***CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***

This role supports Medicaid value-based care and provider performance initiatives through advanced analytics, reporting, and data-driven insights. The analyst partners with business, clinical, provider, and operational stakeholders to evaluate value-based arrangements, analyze provider performance, identify opportunities to improve quality and cost outcomes, and support strategic decision-making. Responsibilities include developing and maintaining reports, dashboards, and analytical models; interpreting complex healthcare and claims data; and translating findings into actionable recommendations. The position requires strong analytical, problem-solving, and communication skills, along with the ability to work independently on complex projects.

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, translates 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. Creates 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, or related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

None

EXPERIENCE

Required

3 years of relevant, progressive experience in Industrial Engineering or Operations Research, or related field (exempted experience requirements effective August 2016)

Preferred

• Experience using SQL to query and analyze large healthcare datasets.
• Experience developing dashboards and visualizations using Tableau.
• Experience working with healthcare claims, provider performance, quality, utilization, or value-based care data.
• Experience supporting provider-facing analytics and value-based reimbursement programs.

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 Occasionally

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

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 a