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JOB SUMMARY
This role is a high-impact role responsible for leading complex strategic initiatives aimed at optimizing the organization's programs in a specific business area or discipline. This individual functions as an internal "consultant," taking ownership of critical projects from conception to actionable recommendations, directly influencing strategy and driving measurable improvements in program effectiveness and resource alignment. With a deep understanding of health plan economics and exceptional strategic problem-solving abilities, the incumbent excels at transforming sophisticated ad-hoc analyses into compelling strategic solutions that align with the organization's mission of improving health outcomes and member value.
ESSENTIAL RESPONSIBILITIES
Lead and manage end-to-end strategic projects focused on program optimization across various clinical areas, defining project scope, methodologies, deliverables, and timelines.
Design and execute comprehensive, data-driven strategic analyses to identify significant opportunities for enhancing efficiency, quality of care, and overall program performance. This includes detailed analysis of trends, outcomes, provider patterns, and regulatory impacts.
Translate complex analytical findings and strategic insights into actionable recommendations and compelling business cases for senior management, driving strategic decision-making and investment.
Act as a trusted advisor and internal thought partner to cross-functional stakeholders, including leadership, clinical operations, network, finance, and actuarial teams, proactively identifying their strategic needs and proposing analytical solutions.
Proactively identify strategic gaps, emerging challenges, or underperforming areas within existing programs, initiating investigations and developing proposals for improvements.
Develop robust, quantifiable impact models for proposed strategies, and subsequently monitor and evaluate the effectiveness of implemented initiatives against defined objectives.
Mentor and provide guidance to more junior analytical staff on complex problem-solving approaches, analytical techniques, and strategic frameworks.
Prepare and deliver executive-level presentations, distilling complex data into clear strategic narratives and actionable insights for diverse audiences.
Other duties as assigned
EXPERIENCE
Required
5 years of progressive experience in strategic consulting, healthcare analytics, or a similar high-impact role, preferably within a large health plan, managed care organization, or consulting firm focused on healthcare.
5 years of a demonstrated track record of successfully leading complex analytical projects and translating insights into actionable business strategies that drove measurable outcomes.
Preferred
Background in clinical quality improvement or managed care, particularly with experience analyzing payer performance metrics such as denial rates and turnaround times.
Proven ability to leverage healthcare data and audit insights to drive operational excellence and continuous quality improvement initiatives.
SKILLS
Exceptional Strategic Problem-Solving & Critical Thinking: Ability to independently frame complex, ambiguous strategic challenges, develop innovative solutions, and articulate a clear path forward.
Expert-Level Analytical & Modeling Skills: Advanced proficiency in Microsoft Excel for complex data manipulation, statistical analysis, scenario modeling, and financial impact assessment. Experience with other analytical tools (e.g., SQL, Python, R, Tableau, Power BI) is a plus.
Deep Healthcare & Business Area/Discipline Acumen: Extensive knowledge of health plan operations, P&L dynamics, value-based care models, and a comprehensive understanding of various levers and their impact.
Project Leadership & Management: Proven ability to define project scope, manage multiple workstreams, meet deadlines, and ensure successful project execution in a fast-paced environment.
Influence & Stakeholder Management: Superior communication, presentation, and negotiation skills, with the ability to build consensus and influence senior leadership and diverse stakeholder groups effectively.
Mentorship & Development: Experience guiding and developing analytical talent.
Entrepreneurial Drive: Proactive, self-motivated, and capable of identifying strategic opportunities without direct instruction.
EDUCATION
Required
Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
Preferred
Master's degree.
Degrees in a quantitative field such as Economics, Business Administration, Public Health, Health Administration, Finance, Statistics, or a related discipline are strongly preferred.
LICENSES or CERTIFICATIONS
Required
None
Preferred
None
Language (Other than English):
None
Travel Required:
Less than 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based or Remote Position
Physical work site required
Occasionally
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
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, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$86,400.00Pay Range Maximum:
$138,600.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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