Risk Adjustment Strategy Consultant - Analytics Expert

Company: Highmark Inc. Job Description: JOB SUMMARY Elevate your career at Highmark Inc. as a Risk Adjustment Strategy Consultant, where you will play a key role in developing innovative strategies that improve Risk Adjustment Accuracy Management (RAAM) and advance our clinical data strategy. In this dynamic position, you'll utilize your analytical skills and strategic thinking to drive transformative projects that combine both business acumen and technical know-how. By addressing complex business challenges related to RAAM and interoperability, you will conduct in-depth analyses, including market research and forecasting, and provide invaluable insights to senior leadership through tailored recommendations and initiatives that generate meaningful business impact. Location Requirement: This position is hybrid, requiring in-office presence three days a week (Tuesday, Wednesday, and Thursday) for those located within 50 miles of a Highmark office. For candidates outside this radius, remote work options are available. ESSENTIAL RESPONSIBILITIES Collaborate with key stakeholders to identify critical business challenges, apply analytical frameworks, develop solutions, and communicate findings effectively to varied audiences. Lead strategic initiatives, leveraging both internal and external resources as needed. Serve as a subject matter expert, advising Strategic Operations staff and stakeholders on membership, growth, and operational strategies. Mentor junior team members, aiding in their professional growth, and participate in performance evaluations and project-based leadership roles. Establish best practices for analytical methodologies to adeptly address strategic issues. Perform additional duties as assigned or necessary. EDUCATION Required Master's degree in Business, Healthcare, Economics, or a related field. At least 2 years of post-graduate experience in strategy or management consulting, or within internal strategy teams at healthcare organizations. A minimum of 6 years of relevant experience in Business or Healthcare. Substitution A Bachelor's degree combined with 3 years of progressively responsible strategic experience may be considered in lieu of a Master's degree. PREFERRED QUALIFICATIONS In-depth understanding of Health Insurance and Provider operations, particularly in Risk Adjustment. Experience in operational improvement and process optimization initiatives. SKILLS Exceptional analytical and problem-solving skills. Strong proficiency in MS Office, particularly PowerPoint and Excel. Current knowledge of healthcare industry trends and challenges related to interoperability. Hands-on experience with clinical data standards (FHIR, CDA, HL7). Familiarity with data integration technologies and cloud platforms for business solutions. Ability to translate business requirements into technical specifications. Solid understanding of healthcare IT security and privacy regulations (e.g., HIPAA). Excellent critical thinking and communication skills, suited for engaging diverse audiences. Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS Position Type: Office-based, with occasional travel to various sites as required. Physical work site required: Yes; may involve occasional lifting of up to 10 pounds. Disclaimer: This job description outlines the essential functions of this role and may not encompass all responsibilities and qualifications. Compliance Requirement: Legal compliance and adherence to ethical standards, including HIPAA and data security guidelines, are mandatory. Pay Range Minimum: $92,300.00 Pay Range Maximum: $172,500.00 Base pay is determined based on various factors including qualifications, experience, and market considerations. Highmark Health and its affiliates are committed to equal opportunity and prohibit discrimination of any kind. For assistance related to equal access or the application process, please contact HR Services Online. Req ID: J273804

Created: 2026-03-12