Job Overview
Location
PA, Working at Home - Pennsylvania
Job Type
Full-time
Category
Data Science
Date Posted
July 4, 2026
Full Job Description
đź“‹ Description
- • Serve as a Senior Provider Analytics Consultant focused on data management, regulatory compliance, and automation within provider functions for a Health Insurance Managed Care Organization (MCO).
- • Develop complex internal and external provider reports and analytic tools that highlight key performance indicators for value-based reimbursement programs and identify financial/quality trend drivers.
- • Engineer self-service reporting capabilities to enable independent use by customers and stakeholders across the enterprise.
- • Design and build advanced scorecards and dashboards using SAS, SQL, Excel, and Power BI to support value-based reimbursement arrangements with strategic market partners.
- • Interpret raw claims, provider, quality, and member data to construct analytical datasets for reporting and decision-making purposes.
- • Lead provider cost savings analyses tied to value-based reimbursement, evaluating return on investment and proposing cost-reduction initiatives grounded in market dynamics and historical outcomes.
- • Report on financial outcomes of provider arrangements and incentives, identifying risks, opportunities, and scenarios to achieve targeted results.
- • Automate and optimize M365 tools to streamline team workflows and improve operational efficiency across provider analytics functions.
- • Ensure regulatory compliance with CMS and state-specific provider data requirements, maintaining accuracy in all reporting outputs.
- • Apply deep knowledge of provider network management and network adequacy standards to inform analytics and program design.
- • Collaborate across multiple analytic teams to ensure comprehensive, accurate, and aligned reporting across enterprise initiatives.
- • Act as a subject matter expert on provider data, providing expert consultation and decision support to team members and senior leadership.
- • Proactively identify opportunities to improve existing reports and processes, sharing best practices and mentoring less experienced staff.
- • Communicate complex analytical insights clearly and confidently to non-technical stakeholders, fostering understanding and buy-in for data-driven strategies.
- • Maintain strict adherence to HIPAA, data security policies, and company privacy practices when handling protected health and member information.
- • Travel up to 25% for meetings, training, or site visits, though the role is primarily remote within Pennsylvania.
- • Perform other duties as assigned to support evolving analytics and compliance needs within the provider functions.
🎯 Requirements
- • 10 years of relevant analytic work experience
- • US Citizen (due to contractual/access requirements)
- • Proficiency in Excel, SAS, SQL, and Power BI
- • Bachelor’s degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics, or related field (or 6 years of relevant work experience in lieu of degree)
- • Deep familiarity with CMS and state provider data requirements
- • Strong knowledge of provider network management and network adequacy standards in a Health Insurance MCO environment
🏖️ Benefits
- • Base pay range of $102,700 to $164,600
- • Remote work option within Pennsylvania
- • Opportunity to mentor and train less experienced staff
- • Exposure to enterprise-wide value-based reimbursement initiatives and strategic partner reporting
- • Compliance with HIPAA and company data security policies
- • Adherence to Highmark Health’s Code of Business Conduct and ethical standards
Skills & Technologies
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About Highmark Health
Highmark Health is a Pittsburgh-based integrated health care delivery and financing system. It combines the Highmark Inc. insurance business with Allegheny Health Network hospitals and physicians, plus a growing portfolio of health services companies. The not-for-profit system serves millions of members across Pennsylvania, West Virginia, Delaware, and New York, offering medical, pharmacy, dental, vision, and behavioral health benefits while operating inpatient and outpatient facilities, research programs, and community health initiatives aimed at improving population health outcomes.
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