Senior Decision Support Consultant

Company : Highmark Inc.

Job Description : JOB SUMMARY

This position serves as a critical business-to-technical liaison, bridging the gap between business needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, and support various complex projects and data analyses. A primary responsibility is to transform loose business language and high-level business needs into precise technical requirements, while also being capable of developing technical solutions. The consultant will act as a senior resource within the team, fostering business-to-technical collaboration and providing strategic consultation directly to department leadership through engagement with business stakeholders. They will advise and consult on Enterprise Informatics strategy, business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization, and the use and planning of technology. The role involves executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level oversight to lower-level analysts through all stages of project design and analysis. The incumbent will utilize advanced technical skills, a deep understanding of core business units, their processes, and relevant data flows to prepare and analyze large, complex datasets, ensuring a robust analytical and financial analysis capability for Highmark's pharmacy and medical benefit specialty drug management programs. Furthermore, the incumbent will utilize advanced knowledge of corporate systems and data sources across Highmark's business units, coupled with a general understanding of data flows from various corporate systems (e.g., claims, billing, lab, and Rx), to solve complex issues and problems. A comprehensive understanding of healthcare terminology, techniques, and reimbursement mechanisms, both within the healthcare industry and Highmark, is essential.

ESSENTIAL RESPONSIBILITIES

Consultation

Provide insight into Enterprise Informatics analyses and provide consultative guidance to Highmark partners .

Key business contact throughout numerous business units that may assist in the resolution of issues or problems.

Access, review, utilize, contribute content to and participate in the maintenance of the shared Enterprise Informatics Intellectual Capital Repository to include but not limited to, review / editing of content submissions and best practices, audit reports, etc. The incumbent is expected to make major contributions to the Repository.

Performs Enterprise Informatics liaison advocacy for emerging areas of Highmark business and leads support liaison advocacy on behalf of selected Highmark business areas. Advocacy involves the representation of the business partner's critical business objectives when prioritizing new work requests vis-à-vis existing workload and resource commitments

Provide overall technical direction (analytic and / or computing) of complex projects to creatively implement effective decision support applications and consultation on the design, testing, and enhancement of reporting systems. Recommends improvement to plan design

Provides feedback to various areas in order to improve service delivery and enhance program design efforts.

Develop and foster relationships across Highmark and with professional organizations, user groups and industry trade groups to stay current with technology and analysis methods.

Modeling & Methodologies

Work independently or leading a multidisciplinary team, designs and implement new analytic models and methodologies of a complex nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance, and conducting other general decision support activities

Lead special complex studies, computer simulations, statistical testing and projects to solve unique problems / questions identified by middle / senior management, business partners, coalitions and governmental agencies. These studies and projects may involve all aspects of the health insurance business and care management processes and may be confidential in nature or for public dissemination.

Performs or leads staff in the development and maintenance of highly complex computer programs using 4GL programming languages and other advanced database / SQL technology, statistical modeling, system testing activities, lead initial problem identification and resolution activities, maintains program / system documentation and prepares / maintains operations documentation for assigned applications.

Utilize or lead the integration of data obtained from external sources such as HC4, HMS, Medco, Acxiom, NCQA, and BCBSA with internal Highmark data. This position routinely utilizes data including, but not limited to : medical / surgical physician and institutional claims and encounters, clinical data, prescription drug data, membership data, dental and vision claims, provider data, financial data (i.e., revenue, premium, billing, pricing) and a variety of external normative and benchmark data.

Lead the evaluation and selection of new complex clinical and technical products and methodologies necessary to enhance current capabilities and positively impact corporate performance

Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results of Health Management interventions and initiatives.

Project Management

Execute all facets of the Informatics project management process and lead multiple project managers.

Independently complete problem definition, requirements gathering, analysis design, statistical testing, results interpretation, and presentation of findings (online, written or verbal).

Independently ensure that the resulting methodologies / processes / software systems are compatible with the corporate technology architecture and is responsible for planning and managing the ISG implementation of the new function / object into the production processing environment.

Identification of parallel issues and project needs in medical and / or business literature

Other duties as assigned or requested.

PREFERRED RESPONSIBILITIES

QUALIFICATIONS

Minimum

Bachelor's Degree or relevant experience and / or education as determined by the company in lieu of bachelor's degree

10-15 years experience in support of a Marketing function or Data Analyst role or in a business environment with responsibility for application of technology in the solution of business problems.

10-15 years experience in querying relational databases utilizing 4GL programming languages such as : SAS and SQL.

10-15 years experience performing project management activities, such as

Problem identification

Meeting project standards and deadlines

Collection of sufficient & accurate information

PREFERRED

• Master's degree in or related to Computer / Information Science, Mathematics / Statistics, Economics, Industrial Engineering or Operations Research

SKILLS

Demonstrated strong programming skills, with an emphasis on the utilization of SAS and SQL, or comparable 4GL programming language, in querying relational databases.

Demonstrated understanding of relational databases and normalization schema, data source availability, interpretation of field elements, their application and interrelation and file structures and system requirements necessary in accessing information and in investigating and attempting to resolve data anomalies.

Strong knowledge of other Highmark business areas, their processes and data flows as they impact analyses performed by Informatics, including knowledge of file structures, system requirements, processes and functionality.

Demonstrated advanced skills and experience using sophisticated analytic techniques and tools to solve complex problems and reveal insights derived from data analysis not readily apparent through the application of more standard techniques and tools.

Demonstrated ability to concurrently perform multiple complex tasks as directed or as needed, in a manner that maximizes productivity.

Demonstrated strong written and verbal communication skills with an emphasis on management-level consultative customer service, conflict resolution, interpersonal and group / meeting presentations or participation in meetings involving technical, non-technical and customer associates or audiences.

Strong understanding of the terminology, techniques, and reimbursement mechanisms employed in the delivery of healthcare is necessary.

Preferred Skills

Experience and demonstrated proficiency as a Decision Support Analyst or equivalent training and experience in a business, specialty pharmacy, clinical pharmacy or clinical environment with direct responsibility for applying technology.

Demonstrated experience and proficiency using 4GL programming languages (such as R, Python, SAS, SQL) and other

Database technology (Hadoop, DB2, Teradata, Oracle, Google Cloud).

Demonstrated experience in building data products using PowerBI.

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 : $78,900.00

Pay Range Maximum : $147,500.00

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.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID : J271594