Highmark jobs in Washington, DC

This job supports the matrixed strategic design and analytical approach to reimbursement. To be successful, the incumbent will work closely with stakeholders across the enterprise in the development and implementation of an integrated roadmap for the introduction and delivery of new and innovative reimbursement models across all of Highmark's markets and lines of business. This will require aligning new models to the health plan's strategic objectives based on a deep understanding of innovation and industry trends in both the commercial and government lines of business. This team will be responsible for supporting development and maintaining models that will drive both the return on investment (ROI) and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this team is responsible for identifying those gaps, building requirements to drive the development of new capabilities, and tying them to Highmark's strategic capability roadmap. They will need to work effectively across teams to inform and influence change to drive adoption and ROI realization. Critical partners include Advanced Analytics, Contracting, Market and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. + Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for both government and private payers. Programs will include but not be limited to fee for service, pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models across all lines of business with the goal of maximizing quality while reducing healthcare costs. Develops and maintains a 3-5 year strategic roadmap outlining current and future reimbursement designs across markets and lines of business with input from key executives across the organization. It will require that this team keeps abreast of new developments in both the public and private reimbursement space, including new innovative models developed by CMS to ensure seamless integration and that the organization is ahead of the curve with regard to our strategy. + Work in a Health Economist approach to build and maintain analytical models that performs evaluation of reimbursement models. Continuously evaluates models and seeks for innovative ways to make improvements based on data and market research. Working closely with Contracting and Provider Relation Leaders and others across the enterprise to develop targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation. + Develop and maintains strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders. Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners. + Other duties as assigned or requested. **EDUCATION** **Required** + Bachelor's Degree in Business, Finance, Healthcare Administration, or Related Field **Substitutions** + 6 years of relevant work experience **Preferred** + Master's Degree in Business or Healthcare Administration **EXPERIENCE** **Minimum** + 7 years Healthcare, Healthcare Insurance, Consulting or related area + 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery or related areas + 4 years Research and strategic planning around emerging trends in reimbursement, network, and payment model design. Demonstrate of the application of healthcare economic drivers and/or population health based analytics To include + 1 year Experience working with technology vendors, and other service provider solutions to source key capabilities + 2 years Proven experience in working in a Health Economist capacity driving understanding of current health trends. **Preferred** + 5 years Familiarity with alternative care model designs (e.g., patient centered medical home, ACO), alternative reimbursement models (e.g., bundled payments), and provider / health plan quality programs (e.g. pay for performance) + 5 years Familiarity with the delivery of health care services across the continuum and quality metrics. + 5 years Experience in running large cross organizational programs and projects + 5 years Familiarity with health plan and provider contracting or revenue management + 2 years Understanding of provider contract documents and overall contract management process **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Excellent written and oral communication skills with the ability to present complex information clearly and persuasively. Including excellent leadership skills, with the ability to relate to all levels of management and staff as well as individuals external to the corporation + Highly effective oral and written communications skills + Ability to manage multiple, complex projects within prescribed timelines + Proficient in MS Office suite, including Word, Excel, PowerPoint and project management software + High level of autonomy and self-direction, to guide reimbursement model design from concept through to execution + Ability to successfully navigate complex organization, engaging multiple stakeholders to achieve reimbursement objectives + Strong financial background and analytical skills with a deep understanding of the economic drivers of healthcare + Comfort and with real-time calculations of cost, membership, etc. (i.e., "back of the envelope" estimations) **Language: (Other than English)** + None **Travel Requirement:** + 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Frequently Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Does Not Apply Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_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:** $126,400.00 **Pay Range Maximum:** $236,000.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J267196

**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. Willingness to work every other weekend with compensated days off during the work week The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. + Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services + Maintain accountability for productivity, quality, and compliance metrics + Communicate determinations clearly both verbally and in writing + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices + **Willingness to work every other weekend with compensated days off during the work week** **Use your skills to make an impact** **Use your skills to make an impact** **Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills. + Evidence of analytic and interpretation skills, with prior experience working in a team environment **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists + The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals. + Ability to thrive in a dynamic fast-paced, team-oriented environment. + Commitment to a culture of innovation, including being facile with using technology to improve workflows + Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director. Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner May participate on project teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-31-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial. **Become a part of our caring community and help us put health first** The Strategy Advisor (Distribution) provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for the Enterprise Growth vertical. The Strategy Advisor's work involves complex assignments performed without direction where the analysis of situations or data requires an in-depth evaluation of variable factors. This work may require leading end-to-end strategy engagements. As part of the Strategy Advancement team, this role will support MarketPoint's investment rationalization and strategic planning efforts. The role requires comfort with ambiguity and creating new solutions in the "white space" where answers are not clear cut or readily available. A successful candidate will be someone who has worked for several years in large matrixed organization (e.g. a publicly traded corporation or large not profit organization) or has several years' experience with stakeholder management (strategy/operations at a top-tier consulting/professional services firm). They will have a demonstrated ability to synthesize large amounts of information into clear and concise outputs (PPT, Excel). This person must be comfortable working collaboratively with senior leaders and subject matter experts alike and should have a high degree of executive presence leading engagements with these stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and deadlines. Healthcare experience is a plus, but not required, though must have a history of mastering an understanding of their prior industry. Other examples of the kind of work required from this role include leading the analysis of complex business problems and issues using data from internal and external sources. The candidate should bring expertise or identify subject matter experts in support of multi-functional efforts to identify, interpret, and produce strategic recommendations and plans. The candidate's work will substantially shape the thinking of distribution org. They will exercise independent judgment and decision making on complex issues to determine the best course of action and work under minimal supervision. **Use your skills to make an impact** About the team: Humana's distribution organization, MarketPoint, plays a key part in driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was created to help transform Humana's customer acquisition approach. The team functions with a mandate to think creatively, discover new opportunities and re-envision operations to drive growth and deliver a first-class experience to our members and agents. **Responsibilities:** + Leads multiple short- and long-term work streams sometimes across engagements, including hypothesis development, working sessions, and report-outs with leaders across the company, and documenting key ideas and actions to drive follow-up actions + Partners closely with finance, analytics, and operators to optimize, track, and report out on internal and external compensation strategy and results + Develop high-quality analysis and deliverables that clearly frame organizational objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations + Lead multiple cross functional investment sizing workstreams and provide high-level support for senior leaders to make informed decisions + Identify new growth avenues of opportunity through independent analysis and presents actionable findings + Lead key portions of presentations at high-visibility meetings + Assist MarketPoint leadership in communicating value and impact of MarketPoint initiatives to broader Humana organization + Coach junior team members to develop technical and professional skillsets **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + **3+ years** of progressive experience consulting in finance, strategic planning, or related roles. + Proven track record in **building compensation models** and **incentive design frameworks** . + Advanced proficiency in **financial modeling and Excel** + Demonstrated experience **managing large, complex budgets** and guiding senior leadership through **trade-off decisions** . + Strong background in **business case development** , including **value sizing** , ROI analysis, and scenario modeling. + Ability to influence and partner with senior executives to drive strategic decisions. + Exceptional analytical and problem-solving skills with a focus on **data-driven decision-making** . + Strong communication skills to present complex financial concepts clearly to non-financial stakeholders. **Preferred Qualifications** + Healthcare industry experience, preferably in the managed care or provider sector + Experience in **compensation strategy** within large organizations. + Exposure to **enterprise-level budgeting and resource allocation** . **Additional Information** **- Position does have the potential for up to 5% travel.** **- Position will be working Eastern (EST) hours.** **Virtual Pre-Screen** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Work-At-Home Requirements** At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-28-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Associate Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **In addition, the Associate Actuary will:** + Support long term projects aimed at advancing technical maturity, process efficiency, and forecasting accuracy. We are looking for creativity, curiosity, and a desire to explore and influence uncharted territory. + Conduct independent research, collaborate across many teams/departments, and require strong communication skills to be successful in the job. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + Meets eligibility requirements for Humana's Actuarial Professional Development Program (APDP) + MAAA + Strong communication skills + Demonstrated ability to communicate technical information with audiences not in the actuarial space + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + 3+ years health industry experience with ASA, or 1+ years health industry experience with FSA + 2+ years SQL experience, or equivalent skillset **Preferred Qualifications** + Medicare Advantage background + Creative, high degree of self-accountability + Experience in Python, PowerApps, and PowerBI Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-30-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**MUST BE A US CITIZEN ** This role will serve as a link between underwriting operations, financial strategy, and process optimization. The incumbent will apply strong analytical and financial acumen to understand, document, and improve processes within the underwriting lifecycle, ensuring efficiency, compliance, and alignment with financial objectives. While primarily focused on process improvement, this role will also support critical underwriting functions, leveraging data to drive strategic decisions and operational excellence. **ESSENTIAL RESPONSIBILITIES** + Create comprehensive process maps and documentation for underwriting procedures, identifying current state operations, future state recommendations, and potential financial impacts. + Develop desktop procedures and training materials specific to underwriting functions, ensuring clarity for audit and compliance. + Collaborate closely with underwriters to analyze existing processes and tools, identifying opportunities for financial efficiency, risk mitigation, and improved quote/renewal turnaround times. + Conduct analyses to quantify the financial impact of proposed process changes or tool enhancements, ensuring data-driven recommendations. + Actively participate in and support project meetings related to underwriting system enhancements, financial modeling tool development, and overall operational efficiency initiatives, ensuring the underwriting perspective is well-represented. + Support underwriting workloads by calculate rates utilizing Company rating algorithms, adjusting accordingly to cover questionable claim patterns or unusual situations not otherwise contemplated within the standard formula. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's Degree in finance, Accounting, Economics, Business Administration, or a related field. **EXPERIENCE** **Required** + **MUST BE A US CITIZEN ** + 3 - 5 years of experience in a Business Analyst or Business Process Analyst role or experience in a related operational area (e.g. claims, billing, customer service, etc.) **Preferred** + Experience in a financial analysis, underwriting support, or actuarial support role is highly desired. Strong understanding of financial concepts, risk assessment, and insurance product lifecycles. **LICENSES OR CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Analysis of business problems/needs + Written & Oral Presentation Skills + Business Analysis + Business Process Design + Business Process Improvement + Business Process Mapping + Business Requirements + Collaborative Problem Solving + Project Management **Languages (other than English)** None **Travel Required** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Remote Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Never Lifting: 25 to 50 pounds Never **_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 position 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:** $50,200.00 **Pay Range Maximum:** $91,200.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273104

Applicants must be authorized to work in the U.S. independently. At this time, we do not offer visa sponsorship for this role. **SUMMARY OF JOB RESPONSIBILITIES** This job has the goal of providing the opportunity to acquire practical experience through direct exposure to the related business line(s) and to develop the next generation of diverse business professionals. To that end, the program will provide hands-on training and experience in the business line, expose the various career opportunities in the business line and related areas, and prepare participants for positions in the business. Typical responsibilities include, providing services to the day-to-day operating objectives of the assigned area, participating in projects and programs appropriate to the needs of the assigned area, participating in the planning and implementation of projects and initiatives, conducting research and reporting including recommendations or proposals for action. This internship offers a dynamic opportunity to contribute to enhancing our customer experience through both data-driven insights and digital design projects. On a daily basis, the intern will support the CXIA team by assisting with customer survey reporting, developing and testing new feedback tools, and helping to maintain and update our website using basic HTML. They'll gain hands-on experience in analyzing customer data, drafting digital communications, and collaborating with our CX and Digital Marketing analysts to optimize the customer journey for United Concordia Dental. AI tools background is also a plus. **REQUIRED QUALIFICATIONS** + Full or part-time enrollment in an accredited college or university baccalaureate program. **PREFERRED QUALIFICATIONS** + Graduation date: 2028 + Relevant Coursework: Studies in Customer Experience, Marketing Analytics, or Web Design. + Analytical Skills: Experience with data analysis or survey platforms. Web/Digital Proficiency: Basic HTML/CSS knowledge and interest in digital content. + Communication: Proven ability to draft clear, customer-focused digital content. + Problem-Solver: Proactive mindset with strong problem-solving and organizational skills. + AI Interest: Curiosity about AI tools for data analysis or digital optimization. **ESSENTIAL JOB FUNCTIONS** 1. Communicate effectively while interacting directly with colleagues, clientele, and/or other internal or external constituencies in the planning of assignments and the resolution of day-to-day operational problems. 2. Under supervision, provide entry-level professional services as appropriate to the day-to-day operating objectives of the area. Receives guidance, training, and mentoring from senior personnel in planning and carrying out activities and assignments. 3. Undertake and/or participates in projects and programs designed to develop professional skills and expertise appropriate to the needs of the organization. 4. Participate in the planning and implementation of unit projects and initiatives within area of expertise and ability. 5. As specifically requested by management, conduct research and reporting inclusive of recommendations or alternative proposals for action. 6. Undertake related studies or enrichment programs as appropriate to the specific objectives of the operating unit. 7. Perform miscellaneous job-related duties as assigned. 8. Customer Experience Insights & Analytics: Support member survey reporting, develop and test customer feedback surveys, and assist with data visualization and analysis. 9. Digital Experience & Web Support: Contribute to website updates (including basic HTML), draft customer email communications, and collaborate on digital content initiatives. Utilize AI support to improve our designs as needed. 10. Research & Reporting: Conduct research on CX best practices and prepare summaries of project findings and recommendations. **_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 position 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:** **Pay Range Maximum:** _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J270617

*****CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***** **Candidates within a 50-mile radius of a Highmark office (Pittsburgh or Mechanicsburg) are required to work on-site Tuesdays, Wednesdays, and Thursdays, from 8:00 AM to 5:00 PM EST. Those residing outside this 50-mile radius will be required to travel to Pittsburgh for an annual meeting.** This job is an integral member of one of our teams responsible for supporting the design, development, and maintenance of our technical solutions, ensuring their efficient and reliable operation. This position will be responsible for the system administration of the Starburst Enterprise Platform (SEP) within the organization. Eligible candidates must have a strong knowledge and proven work experience with the infrastructure components of SEP and its supporting technologies. They will work closely with other technical professionals, analysts, and engineers to build and optimize solutions, ensuring quality, integrity, and performance. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of technical initiatives. The incumbent, and team, may be involved in every aspect as a part of the technical process from idea generation, analysis, design, build, and support using various technologies and design patterns. **ESSENTIAL RESPONSIBILITIES** + Responsible for one or many of the following tasks: analyzing, designing, coding, testing andimplementingtechnical solutions, as well as providing general production monitoring and support, meeting defined scope, target dates and budgets with minimal or no defects. + Collaborate with stakeholders across IT, product, analytics, and business teams to gather requirements and provide technical solutions that meet organizational needs + Monitor work against production schedule andprovide progress updates and report any issues or technical difficulties to leadership on a regular basis. + Document technical processes and procedures, and participate in technical reviews and knowledge sharing sessions + Collaborate on the design and implementation of with architecture to ensure solution alignment to enterprise goals and standards + Perform technical analysis and provide insights to support decision-making across various departments + Stay up-to-date with the latest relevant technologies and industry best practices + Other duties as assigned or requested. **EXPERIENCE** **Required** + 3 years of experience in one or many of the following tasks: analyzing, designing, coding, testing and implementing technical solutions, as well as providing general production support, meeting defined scope, target dates and budgets with minimal or no defects + 3 years of technical problem solving, solution implementation, team/project collaboration experience + 3 years of basic computer science concepts and principles, common operating systems, development languages/scripting **Preferred** + 3 years experience installing, configuring, deploying, upgrading and managing Starburst Enterprise Platform (SEP) with a thorough knowledge of Starburst / Trino's distributed architecture, including coordinators, workers, and connectors. + 5 years experience in managing software applications using Infrastructure-as-Code (IaC) techniques and tools including Gitlab, Terraform, Ansible, Helm Charts, .yaml code, config properties, etc + 5 years experience with SEP security features, including authentication using LDAP, Kerberos, or OAuth and Role-Based Access Control + 5 years experience with various SEP data source connectors (e.g., Oracle, DB2, Teradata, S3, PostgreSQL, MySQL, etc) and their configuration within Starburst. + 5 years experience with monitoring, scaling, and troubleshooting SEP clusters. + 5 years experience identifying key metrics for Starburst platform health and performance, set up alerts, and analyze logs for root cause analysis. + Strong SQL skills, particularly with Trino's dialect and optimization techniques with the ability to analyze query plans, identify bottlenecks, and apply optimizations (e.g., query tuning, resource allocation, caching strategies). + Experience with the Google Cloud Platform and it associated services a plus. **SKILLS** + Demonstrated ability to achieve stretch goals in a highly innovative and fast-paced environment + Adaptability: Ability to take on diverse tasks and projects, adapting to the evolving needs of the organization + Analytical Thinking: Analytical skills with a focus on detail and accuracy + Interest and ability to learn other technologies as needed + Technical Proficiency: Comfortable with a range of data tools and technologies, with a willingness to learn new skills as needed + Track record in designing, implementing, and/or supporting large-scale technical solutions + Sense of ownership, urgency, and drive + Demonstrated passion for user experience and improving usability + Team Collaboration: A team player who can work effectively in cross-functional environments **EDUCATION** **Required** + Bachelor's degree in Computer Science, Information Systems, Computer Engineering or relevant experience and/or education as determined by the company in lieu of bachelor's degree. **Preferred** + Master's degree in Computer Science, Information Systems,Computer Engineering or related field. **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office- or Remote-based Teaches / trains others Occasionally Travel from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_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._ 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J271372

This job is responsible for developing the strategy, planning and delivery of all aspects related to data governance, data warehousing, data management and related efforts for the organization. Directs the coordination of involvement of all business area Subject Manager Experts (SMEs) and other staff members. Promotes the proliferation of a data driven organization in end-user processes and the integration of applications; as well as the promotion of enterprise-wide thinking among business and technical areas. Responsible for defining, documenting, and making available data sources of truth throughout the enterprise. Participation in project management and budgeting to assure data related projects are included in the organizational roadmap and produce tangible results. Champions the use of data as an asset across the enterprise. Improvement and maturity of data sources to move through the life cycle of data, information, and knowledge. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority. + Assure all related projects or initiatives are delivered on time, within the specified budget and in accordance with the agreed upon scope. + Define, build, and maintain a data warehouse/big data platform and associated data stores that maintain an enterprise focus and meet the needs of its varied stakeholders. + Ensure that decisions are made reflecting that position and carefully managing on the part of the incumbent to satisfactorily resolve situations with competing priorities or different perceptions, particularly among senior management. + Communicate and act as the ambassador for data management and data governance within the organization, which includes upward and downward communication of the outcomes produced through the efforts of the team and driving the organization to a data-driven operating approach. + Accountable for service level agreements and expectations with end-users and external stakeholders. + Ensure that the Enterprise Data Warehouse (EDW)/Big Data platforms meets the needs of its customers. + Deliver/manage/monitor all data extracts, both to internal and external constituents. + Other duties as assigned or requested. **EDUCATION** Minimum + Bachelor's Degree in Business, Information Science or other related area, or relevant experience and/or education as determined by the company in lieu of bachelor's degree Preferred + Master's Degree Business, Information Science or other related area **EXPERIENCE** **Minimum** + 10 years of information technology experience functioning in a data warehouse environment to include at least 5 years' performing in a managerial capacity + 3 years of healthcare related experience + Experience developing strategic plans and/or product road maps and communicating technical concepts to varying audiences + Experience acting as liaison between business and technical teams, translating business terms to technical needs **Preferred** + None **SKILLS** + Analytical and problem solving skills + Project management experience with multiple major development projects, demonstrating leadership skills and a track record of managing technical/business staff, financial resources and outside vendors + Strong teamwork and interpersonal skills + Ability to lead process improvement initiatives + Strong knowledge and understanding of business needs + Ability to establish and maintain high level of customer trust and confidence + Demonstrated abilities in relationship management + Strong communication skills **LICENSES AND CERTIFICATIONS** **Required** + None **Preferred** + PMP **TRAVEL REQUIREMENT:** 0 - 25% **LANGUAGE REQUIREMENT (** **_other than English_** **)?** _None_ **PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS** **Position Type** Office-Based **Office-Based Positions** An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours. Teaches/Trains others regularly Frequently Travels regularly from the office to various work sites or from site-to-site Does Not Apply Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply Physical Work Site Required Yes Lifting: up to 10 pounds Does Not Apply Lifting: 10 to 25 pounds Does Not Apply Lifting: 25 to 50 pounds Does Not Apply **_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 position 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:** $126,400.00 **Pay Range Maximum:** $236,000.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J271608

"A Day in the Life" video (***************************** **Opportunities with Genoa Healthcare.** A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, medication management and more - are leading the way to a new level of care. Genoa is a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Join us to start **Caring. Connecting. Growing together.** We seek a **Part Time Pharmacy Technician** to support all functions of the Genoa mental health and specialty pharmacy primarily through dispensing medical prescriptions and performing necessary clerical duties while under the direct supervision of a Registered Pharmacist. **Hours** : This is a Part time, 24 hour role where we are looking for you to be able to work 3 days a week. The schedule we are looking to fill for is Monday , Tuesday and Thursday 8:00am - 4:30pm EST with lunch from 12:30pm-1:00pm EST, however the manager is flexible with working with you on the 3 days a week that can be worked based on business needs **Location** : 801 Pennsylvania Ave. SE, Room 120, Washington, DC 20003 **Primary Responsibilities:** + Provides exceptional customer service to all consumers and members of the clinic staff + Fills prescription orders and makes them available for verification under direct supervision of the registered pharmacist + Orders, receives and stores incoming pharmacy supplies + Receives and processes wholesaler medication orders + Verifies medication stock and enters data in computer to maintain inventory records + Works with the Pharmacist to assist in the pharmacy functions and keeping the pharmacy in compliance with all federal and state requirements + Performs various clerical duties relating to the department + Communicates with strong professional verbal and written communication skills + Other duties as assigned **What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active and unrestricted Pharmacy Technician license in Washington, District of Columbia + Access to reliable transportation **Preferred Qualifications:** + National Pharmacy Technician Certification + Pharmacy and prescription data entry experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO #RED

This job serves as the single-point-of-contact for sales teams and assigned customers, delivering insights and recommendations to sales in order to aid customer acquisition/retention while maintaining performance goals. This incumbent will collaborate with cross functional team members on client-level quotes and function as a trusted adviser by providing financial and risk management support to sales as well as strategic insight. **ESSENTIAL RESPONSIBILITIES** + Understand department and the company'sstrategic goals and competitive position and drives client-level results towards these ends. Actively work with Sales team to manage portfolio of clients towards financial and business targets, e.g. membership, revenue, margin, etc. + Proactively draw insights from quote details, client understanding and regional insights to deliver best-possible recommendation to Sales. State and maintain independent perspective, including under pressure from more senior individuals, identifying opportunities and concerns. + Responsible for portfolio of clients through underwriting engagement, from identification through documentation of final sold-contract details + Assess risk by looking at various risk measures such as risk scores, demographic analysis, and turnover considerations. + Serve as the accountable owner for all quotes delivered to sales partners. Develop a perspective on each client package deliverable. Clearly and confidently communicates Underwriting's position on the risk profile of each client + Identify tool improvement needs and communicates needs to Product Development teams + Maintain accurate book management details including concession budget + Other duties as assigned or requested. **Required** + Bachelor's Degree in Science, Technology, Mathematics or related field **Substitutions** + Six (6) years additional experience required in lieu of degree **Preferred** + None **EXPERIENCE** **Required** + 3 years of Health Care Underwriting OR risk mgmt OR actuary work OR applying advanced mathematics to include + 1 years of external client interaction or comparable external interactions **Preferred** + 1 year in Risk Management **OR** of Actuary work **OR** of applying Advanced Mathematics **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Understanding of health products, services, risk assessment and techniques + Consultative mindset + Strong Oral and Written Communications skills **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Rarely Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Never **_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:** $50,200.00 **Pay Range Maximum:** $91,200.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J272541

**SUMMARY OF JOB RESPONSIBILITIES** This job has the goal of developing Python-based microservices and APIs to support GenAI applications. Implementing backend components for RAG and AI agent orchestration. Participating in architecture discussions and contributing to design decisions. Writing unit and integration tests to ensure code quality and reliability. **REQUIRED QUALIFICATIONS** Currently pursuing a Master's in Computer Science, Software Engineering, or a related field. **PREFERED QUALIFICATIONS** + Strong proficiency in Python and backend frameworks (e.g., FastAPI, Flask, Django). + Solid understanding of system design principles, including distributed systems, service orchestration, and API lifecycle management. + Familiarity with cloud-native development and containerization (e.g., Docker, Kubernetes). + Exposure to AI/ML concepts and interest in building software for GenAI applications. + Experience with Git, CI/CD pipelines, and agile development practices. + Bonus: Experience with RAG pipelines, vector databases, or AI agent orchestration. **ESSENTIAL JOB FUNCTIONS** + Build and maintain Python-based microservices using frameworks like FastAPI or Flask. + Design and implement RESTful APIs and backend services for AI-powered applications. + Participate in system design discussions, including scalability + Contribute to the architecture of backend systems supporting GenAI applications, using RAG and AI agents. + Work with cloud platforms (e.g., Azure, AWS, GCP) to deploy and monitor services. + Participate in agile ceremonies, code reviews, and collaborative development workflows. + Assist in performance tuning, logging, and observability of backend systems **_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 position 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:** **Pay Range Maximum:** _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J270835

**Optum is seeking a Care Coordinator - Social Worker to join our HouseCalls team in Columbia, MD. Optum is a clinician-led care organization, that is creating a seamless health journey for patients across the care continuum.** **As a member of the broader Home and Community Care team, you'll provide annual clinical assessments to patients in the comfort of their homes. This important preventive care helps identify and reduce health risks for patients, in addition to coordinating appropriate follow-up care to improve health and well-being.** At Optum, the integrated medical teams who practice within Home and Community Care are creating something new in health care. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We're connecting care to create a seamless health journey for patients across care settings. Join our team, it's your chance to improve the lives of millions while **Caring. Connecting. Growing together.** The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls and Complex Care Management businesses by providing telephonic consultation to plan members and their healthcare providers in a call center environment. This team includes nurse care managers, and social workers. The Clinical Care Coordinator- Social Worker will report directly to the Manager/and or Director of Clinical Operations. The Social Worker performs telephonic consults to identify and assess available services to meet the social service need of the member. The Social Worker assures that members and families are knowledgeable of potential community resources and how to access them. The Social Worker serves as a resource to clinical services staff in dealing with complex psychosocial issues and accessing community resources. **Primary Responsibilities:** + Performing telephonic social work consultations with members promoting high quality community resources + Performing telephonic consults with member's PCP and/or physicians whenneeded + Ensure member has community resources needed + Documenting clinical consultations and resources given, into internal database + Maintaining the clinical integrity of programs offered + Serving as a clinical resource and consultant for other clinicians + Participating in and contributing to staff meetings and other staff development opportunities and interdepartmental work groups + Working with Manager to identify system improvements that could be made to drive operational advancements and efficiencies + Provide cross-coverage support across the team support and assist with special projects, as needed + Other duties as assigned by Manager or Director You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Master's Degree in Social Work + Professional License in good standing for respective discipline + 2+ years professional experience in a social work position with adults in the Medicaid/Medicare population + Experience with arranging community resources + Knowledge of healthcare delivery system + Knowledge of medical terminology + Computer/typing proficiency to enter/retrieve data in electronic clinical records + Proficient with Microsoft Word, Excel, Outlook + Proven excellent written and verbal communication skills + Proven solid interpersonal skills + Ability to work independently, as well as a member of a team + Dedicated work area established that is separate from other living area and provides information privacy + Live in a location that can receive UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service **Preferred Qualifications:** + Telephonic member engagement experience + Knowledge of CMS regulations, Medicare and Medicaid + Bilingual Spanish Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. _OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

**Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. Are you passionate about the Medicare population, looking for a role in management with the ability to directly impact your own income potential? If so, we are looking for licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager, Medicare Sales, motivates and drives a team of Medicare Sales Field Agents who sell individual health plan products and educate beneficiaries on our services in a field setting. Our teams also sell Life, Annuity, Indemnity, Dental, Vision, Prescription plans, and more. Humana has an inclusive and diverse culture welcoming candidates with multilingual skill sets to service our consumers. **This role is** **field** **based, and you will be out and about in the field in the Raleigh** **Durham, NC.** **area working with your team and meeting members face to face. You must reside in Raleigh** **Durham, NC.** **area or be willing to relocate to the area.** In this **field** position, you will; coach, mentor, educate, motivate and train a team of sales individuals. The Senior Manager, Medicare Sales, must have a solid understanding of the market they serve, how to resolve operational problems and provide creative solutions to increase sales while following CMS guidelines. This role also involves cultivating, maintaining, and building relationships with Humana's customers, both internal and external business partners, along with the community we serve through telephonic, virtual, and face-to-face interactions with individuals and groups. Other responsibilities include developing marketing budgets, and looking for branding opportunities. **Use your skills to make an impact** **Required Qualifications** + **Must reside in the** **Raleigh** **Durham, NC.** **area or be willing to relocate** + **Active Health & Life Insurance Licenses** + 2 or more years of sales leadership experience + 6 or more years of experience working in the insurance industry + Must be able to travel up to 50% of the time + Ability to lead a team of sales associates and train them in successful sales techniques, educational presentation skills, utilizing technology tools as well as building relationships with communities and medical providers + Strong aptitude for technology with proficiency in MS Office products, various CRM platforms, and various iPhone app capabilities + Must be a strong leader, strong producer + Strong organizational, interpersonal, communication and presentation skills + Ability to adapt and overcome when necessary + Community Engagement/Grassroots experience in marketing Medicare plans in the community + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits **Preferred Qualifications** + Bachelor's Degree + Prior experience working in Medicare and the health solutions industry + Engaged with the community through service, organizations, activities and volunteerism + Project management background or certification a plus + Bilingual with the ability to speak, read and write without limitations or assistance **Humana Perks:** Full time associates enjoy: + Base salary with a competitive commission structure + Medical, Dental, Vision and a variety of other supplemental insurances + Paid time off (PTO) & Paid Holidays + 401(k) retirement savings plan + Tuition reimbursement and/or scholarships for qualifying dependent children. + And much more! **Social Security Task:** Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website. **Virtual Pre-Screen:** As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes. \#MedicareSalesManager \#MedicareSalesReps Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $77,000 - $105,100 per year This job is eligible for a commission incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-18-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

*****CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***** We are seeking a highly skilled and experienced Oracle Platform as a Service (PaaS) Administrator to join our dynamic team. This pivotal role involves leading the definition and design of complex Oracle Financial PaaS processes and functions, facilitating the development of sophisticated enterprise business solutions, and contributing to strategic initiatives. The successful candidate will play a critical role in ensuring the robust, secure, and efficient operation of our Oracle PaaS environment, balancing functional requirements with service quality and adherence to enterprise policies and security standards. This role also involves providing leadership and mentorship in areas of expertise and architecture to peers, developers, management, and business users. **Key Responsibilities:** + Lead the design and definition of complex Oracle Financial PaaS processes and functions. + Facilitate the development of advanced enterprise business solutions utilizing Oracle PaaS. + Contribute to enterprise strategy development, including opportunity identification and business innovation. + Select and ensure the effective application of appropriate design standards, methods, and tools. + Review application designs to ensure optimal technology selection, efficient resource utilization, and seamless system integration. + Ensure system architecture adheres to functional, service quality, security, and enterprise policy standards. + Participate in customer walkthroughs, technical reviews, problem resolution, and decision-making processes. + Provide leadership and mentorship to peers, developers, management, and business users on Oracle PaaS architecture and best practices. + Manage Oracle Cloud Infrastructure (OCI) resources, including provisioning and maintaining compute, storage (Object Storage, Block Volumes), and networking components (VCNs, subnets, NSGs, security lists). + Administer and configure Oracle PaaS services such as Oracle Integration Cloud (OIC), Autonomous Database (ADW, ATP), Oracle Analytics Cloud, and Oracle FDI, ensuring secure and efficient operation. + Implement and manage Identity and Access Management (IAM) through IDCS or OCI IAM, including role setup, policies, single sign-on (SSO), and application/user provisioning. + Conduct proactive monitoring, performance tuning, and cost optimization of Oracle PaaS environments. + Implement and enforce security best practices, including encryption, patch management, vulnerability scanning, backup/recovery, access audits, Cloud Guard, and Data Safe, ensuring SOX compliance. + Provide frontline support for incident management, diagnosing and resolving platform issues, coordinating with IT teams and vendors, and documenting operational processes. + Develop and maintain automation scripts (Shell, Python) for streamlining tasks, ensuring peer review and version control. + Maintain comprehensive technical documentation, oversee licensing, manage change control, and develop recovery plans. + Collaborate effectively with developers, analysts, and security teams, and potentially mentor junior staff. **Core Skills and Experience:** + **Oracle Cloud Infrastructure (OCI) Expertise:** Compute, Storage (Object Storage, Block Volumes), Networking (VCNs, subnets, NSGs). + **Oracle PaaS Services:** Oracle Integration Cloud (OIC), Oracle Data Integrator (ODI), Identity Cloud Service (IDCS), Autonomous Database (ADW, ATP), Oracle Analytics Cloud (OAC), Visual Builder Cloud Service (VBCS), APEX, WebLogic. + **Database Administration:** Oracle Database administration and data transformation experience. + **Scripting & Automation:** Proficiency in Shell/Bash scripting and Python. Java experience is a plus. + **Security & Compliance:** IAM/Policy configuration, encryption, patching strategies, SOX compliance, and audit experience. + **APIs & Integrations:** Experience with REST APIs and FDI SOAP. + **Performance Optimization:** Proven ability in performance tuning, health checks, and cost tracking. + **Operational Excellence:** Strong skills in incident triaging, technical documentation, backup strategies, and disaster recovery. **ESSENTIAL RESPONSIBILITIES** + Assists in providing strategic consultation to business customers in defining or designing less complex business processes, functions and organizational structures, as well as in researching, identifying and internally marketing enabling technologies based on customer capability requirements. Facilitates development of enterprise business solutions that combine knowledge of particular business processes and issues, general technological options, and process facilitation techniques. Participates in enterprise strategy development, including environmental analysis, opportunity identification, value cases and business innovation portfolio development. + Assists in specifying and designing less complex systems, solutions, networks, infrastructure elements, or processes. Selects appropriate design standards, methods and tools and ensures that they are applied effectively. Reviews others' system design to ensure selection of appropriate technology, efficient use of resources and integration of multiple systems and technology. Establishes policy for selection of architecture components. Evaluates and undertakes impact analysis on major design options. Ensures that the system architecture balances functional, service quality and systems management requirements. + Assists in using appropriate tools, including models of components and interfaces, to contribute to the development of architectures. Produces detailed component requirements, specifications and translates these into detailed solutions/designs for implementation using selected products. Provides advice on technical aspects of system development, integration (including requests for changes, deviations from specifications, etc.) and processes. Ensures that relevant technical and business strategies, policies, standards and practices are applied correctly. + Assists in selecting and using tools and methods to establish, clarify, and communicate the functional and non-functional requirements of system users, their characteristics, and tasks. Identifies the technical, organizational, and physical environment in which less complex products or systems will operate. Identifies, proposes, initiates, and leads improvement programs, taking responsibility for the quality and appropriateness of the work performed and the realization of measurable business benefits. Modifies existing process improvement approaches and/or develops new approaches to achieving improvement. + Assists in ensuring the resolution of a variety of architecture and business problems and serves as a technical or business resource for less complex project initiatives. + Communicates effectively with all levels of organization + Manages expectations of customers, partners and management + Participates in customer walkthroughs and plans; design and technical walkthroughs; and problem resolution and decision making + Interacts with departments across the organization as necessary, including the development and interpretation of less complex requirements for peers and other staff. + Maintains an in-depth knowledge of specific technical aspects in area of expertise and provides advice regarding their application. The area of specific expertise may be any aspect of information or communication technology, technique, method, process, product, or application area. + Provides leadership in the areas of expertise and architecture to their peers, developers, management and business users including technical expertise, coaching, and ad-hoc training by: + Preparing presentations on less complex issues on the area of expertise + Presenting to their peers to ensure consistency to Highmark's strategic direction. + Other duties as assigned or requested. **EDUCATION** **Required** + Bachelor's Degree in Information Technology or related field **Substitutions** + 6 years of related experience in lieu of a 4 year degree **Preferred** + Master's Degree **EXPERIENCE** **Required** + None **Preferred** + Health insurance industry business knowledge **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + Industry certifications **SKILLS** An Architect is not required to have experience in all of these, but is required to have those needed to support applications they are responsible for supporting. Current skill set are reviewed every other year, new skills may be required to meet changing business needs. + Skills: + IMS, DB2, Oracle and Teradata Databases, Data Warehousing + COBAL, Visual Basic, C C++, SAS + Java/JavaScript Framework + PEGA, CSS3, Mobile, JSON, Cognos, Hadoop, SQL, J2EE, HTML5/XML + Project Management Tools: + Waterfall + Agile + Certification in application areas such as: + Java Developer + DB2, Cogno, PEGA, Enterprise Architect(SCEA), Project Management **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never **_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:** $57,700.00 **Pay Range Maximum:** $107,800.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273116

This job performs clinical review and data abstraction of patient records to support compliance with nationally recognized quality initiatives and the network's clinical process improvement and patient safety initiatives. The incumbent requires in-depth understanding of anatomy, physiology and clinical scenarios, critical thinking skills, attention to detail and the ability to meet set deadlines. The incumbent will be responsible for communicating with physicians and staff to seek clarification and provide education as needed. **ESSENTIAL RESPONSIBILITIES** + Abstracts key clinical findings accurately and in a timely manner and performs direct data entry for inclusion into an aggregate database to meet the requirements of the state, internal use, third party payer requirements and external quality improvement participation based on guidelines. Identifies outliers, records them appropriately and seeks clarification as needed. (80%) + Performs system functions such as data imports and exports and report running as needed. (10%) + Participates in ongoing inter rater reliability to ensure accuracy of data abstraction. (10%) + Performs other duties as assigned or required. **QUALIFICATIONS:** Minimum + High School/GED + Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) + 3 years working with cardiovascular patients + 3 years of Strong professional, organizational, communication and inter-disciplinary collaboration skills required to effectively work with all levels of the hospital, including physicians, nursing and support departments + Working knowledge of data reporting requirements for the various participating registries + Able to participate in prioritization of data elements and contribute to workflows for data collection activities + Meets established productivity and accuracy standards + Excellent organizational and communication skills + Ability to perform well with team in a remote work environment + Ability to meet deadlines and appropriately prioritize work for self + Seeks education and training opportunities as needed to maintain skillset + Maintains strict confidentiality in all aspects of work Preferred + Associate's or Bachelor's Degree in Nursing + 1 year performing medical record review and data abstraction for cardiovascular registries + Proficient in the use of computer systems to include Microsoft Office, mainframes and the electronic medical record **_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:** $27.36 **Pay Range Maximum:** $42.41 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273227

This job implements and administers strategic activities related to client retention, growth, and profitability of existing accounts within the assigned market. May also have responsibility for the acquisition and profitability of new accounts. The incumbent motivates and develops team members to achieve and/or exceed upselling opportunities. Responsible for market management (i.e., awareness and management of external distribution channel relationships, competition, media and development of overall market/region strategies). Develops and monitors targets to ensure sales staff meet goals and standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve **This role is looking for someone who has leadership experience with TPA, Stop loss, and self-funded clients.** **ESSENTIAL RESPONSIBILITIES** + Understand and utilize economic, financial, market and industry segment data to accurately diagnose business strengths and weaknesses, identify key issues and implications for potential strategies and plans. + Utilize appropriate financial strategies and systems to achieve financial goals while managing risk to the organization. + Forecast and achieve annual retention goals and objectives to ensure growth and profitability goals are met or exceeded. + Analyze risk and initiate actions that balance risk and profitability to achieve team profitability and client satisfaction. + Continuously monitor and maintain knowledge of the market and competition. + Develop new potential markets and grow existing business for the Organization. + Influence and build effective relationships with business partners (i.e. customers, peers, and Producers). + Develop and maintain effective relationships with clients, consultants, brokers, and peers. + Partner with Distribution Administration to develop and/or strengthen the Organization's relationships with key distribution channels and partners. + Provide input to and execute on the Organization's distribution strategy. + Manage profitability; effective risk and underwriting actions; guide sales of products and services that result in solutions that create value for the client and sustainable profit for the Organization. + Implement and administer strategic activities related to retaining and growing sales within assigned market, including setting goals for enrollment, profitability, and cross-selling. + Serve as a coach for the staff. + Provide the leadership necessary to motivate and develop the account management personnel to achieve and/or exceed sales / retention goals and profitability within assigned market. + Continuously raising expectations to achieve goals while upholding organizational values and standards and tracking progress towards goals. + Other duties as assigned or requested. **QUALIFICATIONS:** **Required** + Bachelor's Degree OR 4 years equivalent work experience may be considered in lieu of Degree. + 5 years of sales experience in health- or insurance-related field + 5 years Health Insurance experience in applicable market segment + State-specific Producer License Life, Accident & Health are required or must be obtained within 45 days of hire **Substitutions** + None **Preferred** + Master's Degree + Leadership & Management experience **Skills** + Demonstrated financial acumen. + Leadership + Coaching + Talent Management + Strategic Thinking + Business Acumen + Communication + Creativity & Innovation + Drive for Results + Evaluates Critically + Influence + Planning & Organization + Problem Solving + Oral and Written skills **SCOPE OF RESPONSIBILITY** Does this role supervise/manage other employees? Yes, number of direct reports: 2+, varies by market. WORK ENVIRONMENT Is Travel Required? Yes **_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 position 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:** $104,000.00 **Pay Range Maximum:** $156,000.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J272300

This job provides Information Security and Risk Management services for the Organization. Works with peers within security, HM Health Solutions customers and application teams to ensure alignment with current and future security needs. Manages activities of various Information Security personnel. Makes decisions on personnel actions (promotions, hiring, terminations, etc.). Develops talent, addresses resource management, cultivates capabilities of staff, planning and coordination of work, and managing performance. Conducts the oversight of security technology products for network, systems, and data. Controls expenses within the operating unit and is responsible for meeting budget goals. Actively contributes to the Information Security ans Risk Management (ISRM) strategic planning process by working with the Directors to develop and implement department strategic plans and action steps that support the corporate strategic objectives. Actively involved in the coordination, implementation, problem solving, communication, and training of new technologies and processes, as they are developed and moved into the environment. Develops and presents Information Security awareness and training programs. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but not limited to: involved in hiring and termination decisions; coaching and development; rewards and recognition; performance management and staff productivity. + Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. + Provide oversight of all aspects of project management to ensure continuous improvement of processes: negotiate and collaborate with leadership and staff to develop security solutions and options; develop and adhere to internal standards and strategies; ensure adherence to approved methodologies; coordinate resources, time, contingency plans and risk management. + Provide leadership to the department: lead and champion organizational change; encourage participation in activities that support relationship development; champion information security innovation; encourage and enforce proper training in regards to security issues. + Ensure compliance to Corporate and Information Security policies, standards and procedures. + Communicate effectively with all levels of the organization: facilitate meetings; plan, design and provide presentations; represent HM Health Solutions with outside entities; prepare divisional procedures, policies, reports and correspondence; spread awareness of new and existing security threats; provide oversight regarding metrics, funding, budgets and resources. + Other duties as assigned or requested. **EDUCATION** **Required** + Bachelor's Degree in Information Security, Information Systems, Information Assurance, Computer Science or related field **Substitutions** + 6 years of relevant experience substitution for a Bachelor's Degree **Preferred** + Master's Degree in Computer Science, Information Security or related field **EXPERIENCE** **Required** + 7 - 10 years in Information Security and/or Information Risk Management and/or Information Technology + 7 - 10 years in developing, communicating and presenting Information Security and Risk Management concepts to varying audiences + 1 - 3 years in mentoring others in a leadership role + 1 - 3 years in Staff Management + 1 - 3 years in developing and executing strategic plans to realize business objectives **Preferred** + 10 - 15 years in Information Security and/or Information Risk Management and/or Information Technology + Experience managing an information security function using the HITRUST Common Security Framework (HITRUST CSF), or the NIST 800-83 cyber security framework + Experience supporting SSAE 16 or SOC 2 Security Trust Principle audits + Experience establishing budgets and meeting fiduciary goals + Security industry organization participation/leadership (HITRUST, ISACA, InfraGard, ISC2, ISSA, etc.) **LICENSES AND CERTIFICATIONS** **Required** + None **Preferred** + Certified Information Systems Security Professional (CISSP) **OR** + Certified Information Security Manager (CISM) **OR** + Certified in Risk and Information Systems Controls (CRISC) **OR** + Information Technology Infrastructure Library (ITIL) **SKILLS** + Knowledge of regulatory requirements such as Health Insurance Portability and Accountability Act (HIPPA), Payment Card Industry Data Security Standards (PCI DSS), and FIPS-140 + Strong teamwork and interpersonal skills + Experience in leading process improvement initiatives + Ability to motivate high performance, multi-discipline teams + Demonstrated competency in project execution + Demonstrated abilities in relationship management **Languages (Other than English)** None **Travel Requirement** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-Based Teaches/Trains others regularly Frequently Travels regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply Physical Work Site Required Yes Lifting: up to 10 pounds Does Not Apply Lifting: 10 to 25 pounds Does Not Apply Lifting: 25 to 50 pounds Does Not Apply **_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:** $108,000.00 **Pay Range Maximum:** $201,800.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J269753

**This is a Hybrid based role - 3 days a week in Pittsburgh - T, W, TH** **SUMMARY OF JOB RESPONSIBILITIES** This job has the goal of providing the opportunity to acquire practical experience through direct exposure to the related business line(s) and to develop the next generation of diverse business professionals. To that end, the program will provide hands-on training and experience in the business line, expose the various career opportunities in the business line and related areas, and prepare participants for positions in the business. Typical responsibilities include, providing services to the day-to-day operating objectives of the assigned area, participating in projects and programs appropriate to the needs of the assigned area, participating in the planning and implementation of projects and initiatives, conducting research and reporting including recommendations or proposals for action. The role is within the health plan finance organization with a specific focus in areas including: + Forecasting financial performance and analyzing financial trends. + Prepare monthly financial reports, analyzing variances against budget, forecast, and prior year. + Collaborate with cross-functional teams (e.g., Actuarial, Sales, Pharmacy, Underwriting) to gather data, understand business drivers, and provide financial insights. + Utilize data analytics and visualization tools to create dashboards and reports that effectively communicate financial performance to stakeholders. + Develop clear and concise presentations to communicate financial insights and recommendations. + Identify and implement process improvements to enhance the efficiency and accuracy of finance business processes. **REQUIRED QUALIFICATIONS** + Full or part-time enrollment in an accredited college or university baccalaureate program. **PREFERRED QUALIFICATIONS** Degree path in one of the following + Bachelor of Science in Finance + Bachelor of Science in Accounting + Bachelor of Arts in Economics + Bachelor of Business Administration (BBA) with a concentration in Finance + Bachelor of Science in Financial Mathematics + Bachelor of Science in Computer Science **Anticipated Graduation date 2027 or 2028** **ESSENTIAL JOB FUNCTIONS** 1. Communicate effectively while interacting directly with colleagues, clientele, and/or other internal or external constituencies in the planning of assignments and the resolution of day-to-day operational problems. 2. Under supervision, provide entry-level professional services as appropriate to the day-to-day operating objectives of the area. Receives guidance, training, and mentoring from senior personnel in planning and carrying out activities and assignments. 3. Undertake and/or participates in projects and programs designed to develop professional skills and expertise appropriate to the needs of the organization. 4. Participate in the planning and implementation of unit projects and initiatives within area of expertise and ability. 5. As specifically requested by management, conduct research and reporting inclusive of recommendations or alternative proposals for action. 6. Undertake related studies or enrichment programs as appropriate to the specific objectives of the operating unit. 7. Perform miscellaneous job-related duties as assigned. **_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 position 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. 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J270566

HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. Responsible for definition, planning and delivery of complex programs that require cross-functional collaboration and management of interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal exempt and/or matrixed employees and contractors that serve on the program(s) to deliver solutions for the business. **ESSENTIAL RESPONSIBILITIES:** + Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects. + Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program. + Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. Acquire understanding of the business objectives for an assigned area." + Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. Direct corrective action as needed to maintain the viability of the Program. + Develop and maintain positive customer relationships. Deliver presentations of project status to effectively communicate throughout the project lifecycle. + Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements. Support and contribute to the improvement of project management methods and practices. + Other duties as assigned or requested. **QUALIFICATIONS:** Minimum + High School Diploma or equivalent + One (1) to three (3) years experience performing project coordination activities such as analysis, information gathering, documentation preparation, project schedule maintenance, status report preparation, budget tracking, etc. Preferred + Bachelor's degree + PMP certification or equivalent training + Health Care Insurance industry business and operational knowledge + Leadership skills + Solid organizational and planning skills + Exposure to an industry standard software development lifecycle + Good verbal and written communication skills + Good interpersonal skills **Knowledge, Skills and Abilities** + Experience with customer relationship management + Presentation skills + Negotiation skills + Experience with conflict resolution + Experience with Risk Mitigation Planning **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_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:** $50,200.00 **Pay Range Maximum:** $91,200.00 _Base 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J271523