Decision Support Analyst - Medicaid Value Based Analytics

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

***CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***

This role supports Medicaid value-based care and provider performance initiatives through advanced analytics, reporting, and data-driven insights. The analyst partners with business, clinical, provider, and operational stakeholders to evaluate value-based arrangements, analyze provider performance, identify opportunities to improve quality and cost outcomes, and support strategic decision-making. Responsibilities include developing and maintaining reports, dashboards, and analytical models; interpreting complex healthcare and claims data; and translating findings into actionable recommendations. The position requires strong analytical, problem-solving, and communication skills, along with the ability to work independently on complex projects.

ESSENTIAL RESPONSIBILITIES

• Develop and foster internal relationships across the corporation.
• Provide analytic and consultative support to a broad spectrum of internal customer areas and external business partners.
• Mentor colleagues with less experience on both the technical and business aspects of project and consultative work.
• Determine how decision support systems will provide information required to make effective business decisions, translates requirements into applications that employ appropriate decision support and reporting tools.
• Use broad experience and technical knowledge to propose solutions to complex business problems.
• Take the lead in driving the implementation of the recommended solutions.
• Take the lead in defining issues and ideas to be studied as well as the approach (methodological and technical) to be used in addressing studies and projects. Creates and/or develop new methods of analysis, database design and performance measurement or, in some cases, adaptation of existing solutions to new areas.
• Perform modeling of data sources and flows, work with data management staff to define an operational framework that will define, develop and implement policies and security frameworks to ensure precise and secure deliver of knowledge and information.
• Provide assistance and, depending on skill and experience, lead with interpretation of raw data, statistical results or otherwise compiled information, identify follow-up action items and prepare or assist in the preparation of written reports and/or oral presentation of findings to internal and external audiences, customer managers, clinical staff, compliance agencies, group accounts, providers, agent plans, and brokers.
• Develop and maintain moderate- to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL) and other database technology (DB2, Teradata, and Oracle).
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, or related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• None

EXPERIENCE

Required

• 3 years of relevant, progressive experience in Industrial Engineering or Operations Research, or related field (exempted experience requirements effective August 2016)

Preferred

• Experience using SQL to query and analyze large healthcare datasets.
• Experience developing dashboards and visualizations using Tableau.
• Experience working with healthcare claims, provider performance, quality, utilization, or value-based care data.
• Experience supporting provider-facing analytics and value-based reimbursement programs.

SKILLS

• Strong technical skills in the mainframe, PC and Internet-based technologies to be effective and must be comfortable and proficient using large and complex databases.
• Strong skills using various third-party office and report generation products such as Microsoft Office, Business Objects, Cognos, and Enterprise Guide.
• Strong communication skills. Must be comfortable presenting findings and offering recommendations to senior management.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Never

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

Occasionally

Lifting: 25 to 50 pounds

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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

About Us

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services.

Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.