Strategic Risk Adjustment Consultant — Remote/Hybrid

Highmark Health; Indianapolis (IN); Hybrid; USD 109,000 - 181,000; Full time

Job summary

Highmark Inc. is seeking a strategic leader to support the Risk Adjustment Accuracy Management (RAAM) department, driving analytics, market research, forecasting, and competitive analysis.

You will develop formal recommendations for senior leaders and craft go-to-market or operational documents informing critical decisions. The role may be hybrid or remote; onsite three days weekly if within 50 miles of an office.

Qualifications

• Masters Degree in business, healthcare, economics or related degree.
• 2 years of post-grad experience with strategy/management consulting firms or internal strategy groups of healthcare companies.
• 6 years of related experience in Business or Healthcare.
• Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree.
• Extensive knowledge of Health Insurance and/or Provider operations.
• Experience in operational improvement.
• Extensive knowledge of government risk adjustment models, CMS-HCC, HHS-HCC, and/or CDPS models.

Responsibilities

• Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
• Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.
• Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
• Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
• Other duties as assigned or requested.

Skills

Strategic thinking

Communication skills

Presentation skills

MS Office (PowerPoint & Excel)

Healthcare industry knowledge

Education

Master's degree in Business/Healthcare/Economics

2 years post-grad strategy/management consulting

6 years related experience in Business or Healthcare

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

Job description

Highmark Inc. is seeking a strategic leader to support the Risk Adjustment Accuracy Management (RAAM) department, driving analytics, market research, forecasting, and competitive analysis.

You will develop formal recommendations for senior leaders and craft go-to-market or operational documents informing critical decisions. The role may be hybrid or remote; onsite three days weekly if within 50 miles of an office.