Remote Strategic Risk-Adjustment Consultant

highmarkhealth; Pennsylvania; Hybrid; USD 120,000 - 190,000; Full time

Job summary

Highmark Inc. seeks a strategic leader to guide the Risk Adjustment Accuracy Management (RAAM) function. You will analyze business issues, design analytics, and craft recommendations for senior leadership, shaping program strategy and operational goals.

Responsibilities include leading risk adjustment initiatives, guiding projects, and developing actionable insights and documents to inform critical decisions for Medicare Advantage, Medicaid, and ACA programs.

Qualifications

• Masters degree in Business, Healthcare, Economics or related field.
• 6 years of related experience in Business or Healthcare.
• Bachelor's degree plus 3 years of relevant strategic experience in lieu of Master's.

Responsibilities

• Identify key business issues with owners and apply analytical frameworks.
• Lead delivery of risk adjustment initiatives aligned with RAAM's plan.
• Manage strategy projects with internal/external resources.
• Serve as SME on Medicare Advantage, Medicaid, and ACA risk programs.
• Provide guidance and training to junior staff; potential project supervision.

Skills

Strategic thinking

Presentation skills

Communication

MS Office

Education

Masters Degree in Business, Healthcare, Economics or related degree

Bachelor's degree + 3 years relevant strategic experience in lieu of Master's

Tools

PowerPoint

Excel

Job description

Highmark Inc. seeks a strategic leader to guide the Risk Adjustment Accuracy Management (RAAM) function. You will analyze business issues, design analytics, and craft recommendations for senior leadership, shaping program strategy and operational goals.

Responsibilities include leading risk adjustment initiatives, guiding projects, and developing actionable insights and documents to inform critical decisions for Medicare Advantage, Medicaid, and ACA programs.