Strategy Consultant - Risk Adjustment

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job supports executive leadership of the Organization with a range of strategic initiatives, specifically focusing on the evolution of Risk Adjustment Accuracy Management (RAAM) and Highmark’s clinical data strategy. Providing analytical/strategic‑thinking and leading project teams, particularly those bridging business and technical functions, to:
1) isolate complex business issues related to RAAM and interoperability;
2) design and execute analytics for studying these issues (market research, scenario planning, forecasting, etc.);
3) develop technical content and serve as a subject‑matter expert on clinical data exchange, interoperability standards, and related technologies;
4) support development of formal recommendations to senior levels of Highmark leadership, ensuring solutions maximize business value and adhere to technical standards;
5) create documents (go‑to‑market or operational strategies, technical roadmaps, etc.) that inform critical strategic issues and decisions, and
6) execute the initiatives.

If you are within 50 miles of a Highmark office this role will be Hybrid onsite 3 days a week. T, W, Th. If you are outside of those 50 miles this role will be remote.

• 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.
• 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 membership, growth and operational strategy issues.
• 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.

Required

• 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

Substitution

• 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, especially related to Risk Adjustment.
• Experience in operational improvement and process optimization.

Required

• None

Preferred

• None

• Strong analytical and problem‑solving skills.
• Strong PC application Skills (MS Office including PowerPoint and Excel).
• Knowledge of healthcare industry trends and challenges, especially in the context of interoperability.
• Hands‑on experience working with and applying clinical data standards (FHIR, CDA, HL7, etc.).
• Experience leveraging data integration technologies and cloud platforms to address business needs.
• Proficiency in gathering and facilitating the translation of business requirements into technical requirements.
• Strong knowledge of healthcare IT security and privacy regulations (e.g., HIPAA).
• Strong critical thinking skills.
• Good communication and presentation skills across various audience levels.

None

0% - 25%

Position Type:
Office‑based. Physical work site required:
Yes.

Lifting: up to 25 pounds (maximum 25–50 pounds) with no overhead limits. Work primarily out‑of‑the‑office selling products/services:
Never.

Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data,…