Strategy Lead: Risk Adjustment Analytics & Insights

Highmark Health; Annapolis (MD); Hybrid; USD 109,000 - 181,000; Full time

Job summary

Highmark Inc. is seeking a Senior role within the Risk Adjustment Accuracy Management (RAAM) department to lead analytics, strategic planning, and project delivery across Medicare Advantage, Medicaid, and ACA lines. Hybrid or remote work available, onsite 3 days weekly if within 50 miles of an office.

You will isolate business issues, design analytics, and develop formal recommendations for senior leadership, creating go-to-market and operational documents to inform critical decisions.

Qualifications

• Masters Degree in Business, Healthcare, Economics or related degree.
• 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, )
• 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, including CMS-HCC, HHS-HCC, and/or CDPS models
• Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation
• Through knowledge of membership, rates, financial and competitive data

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

MS Office (PowerPoint & Excel)

Healthcare industry knowledge

Critical thinking

Communication and presentation

Education

Master's degree in Business/Healthcare/Economics

2 years of post-grad strategy/management consulting experience

6 years of related experience in Business/Healthcare

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

Job description

Highmark Inc. is seeking a Senior role within the Risk Adjustment Accuracy Management (RAAM) department to lead analytics, strategic planning, and project delivery across Medicare Advantage, Medicaid, and ACA lines. Hybrid or remote work available, onsite 3 days weekly if within 50 miles of an office.

You will isolate business issues, design analytics, and develop formal recommendations for senior leadership, creating go-to-market and operational documents to inform critical decisions.