Strategic Risk-Adjustment Analytics Consultant

Highmark Health; Washington (District of Columbia); Hybrid; USD 109,000 - 181,000; Full time

Job summary

Highmark Inc. seeks a strategic leader to guide the Risk Adjustment Accuracy Management (RAAM) program. You will shape analytics, scenario planning, forecasting, and market research to support project teams and leadership decisions.

You will develop competitive insights, guide senior-level recommendations, and craft strategic documents informing critical risks and opportunities for Medicare Advantage, Medicaid, and ACA lines.

Qualifications

• Masters degree in Business, Healthcare, Economics or related field.
• 2 years post-grad experience in strategy/management consulting or internal healthcare strategy groups.
• 6 years related experience in Business or Healthcare.
• Bachelor's degree + 3 years strategic experience in lieu of Master's.
• Extensive knowledge of Health Insurance and/or Provider operations.
• Experience in operational improvement.
• Knowledge of government risk adjustment models (CMS-HCC, HHS-HCC, CDPS).

Responsibilities

• Work with business/ market owners to identify key business issues, apply analytical frameworks, develop solutions and recommendations, and present findings to stakeholders.
• Lead delivery of evolving risk adjustment initiatives aligning with RAAM's strategic plan.
• Manage major strategy projects with internal or external resources.
• Serve as SME to Strategic Operations on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines.
• Provide informal coaching to junior team members; support development/training plans.
• Develop analytical frameworks and best practices for analyzing strategy issues.
• Other duties as assigned.

Skills

Strategic thinking

PowerPoint

Excel

Healthcare trends

Critical thinking

Communication skills

Education

Master's degree in Business, Healthcare, Economics or related field

2 years post-grad experience in strategy/management consulting or internal healthcare strategy

6 years related experience in Business or Healthcare

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

Job description

Highmark Inc. seeks a strategic leader to guide the Risk Adjustment Accuracy Management (RAAM) program. You will shape analytics, scenario planning, forecasting, and market research to support project teams and leadership decisions.

You will develop competitive insights, guide senior-level recommendations, and craft strategic documents informing critical risks and opportunities for Medicare Advantage, Medicaid, and ACA lines.