Bismarck, North Dakota

**Company :**

Highmark Inc.

**Job Description :**

**JOB SUMMARY**

This job supports one or more analytical aspects of the application product life cycle, including capability enablement with cross-team dependencies within a product scope. Leads team members in the configuration tasks related to benefits, prior auth requirements and medical policy, code sets, business rules, screen design and functionality, templates, workflows, user task analysis, personalization to different plans, and user interface design for clinical operations such as Appeals & Grievances, LTSS, Care Management, Utilization Management, and Population Health Management. Supports respective business platforms for the Medicaid Business Unit market served by Highmark. Uses significant judgement and discretion to collaborate with customers on complex issues in order to understand capability needs, gather project specifications, create business cases and cost sheet analysis, translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test cases, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Also responsible for identification, documentation, and resolution of risks, defects, and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate and Intermediate Business Systems Analysts. Leads project teams or actively participate as subject matter expert (SME) on moderately complex projects (which are cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as face to the customer. Resolves very complex issues (may involve multiple systems) while understanding potential regulatory risk exposure and customer service & financial impacts. Acts as a SME on how moderately complex new enhancements/applications are developed using advanced level of understanding of end-to-end process and clear understanding of potential integration issues. Requires advanced level of understanding the end systems impact of changes across multiple/diverse systems (including regulatory risk exposure, customer service & financial impacts).

**ESSENTIAL RESPONSIBILITIES**

Take a lead role with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions on complex issues. Create and maintain deliverables such as business vision, requirements, testing plan, testing schedule, testing scenarios, testing outcomes, user task analysis, wire framing, usability testing, personalization to different clients, and user interface design. Participate in the full software development life cycle by actively taking a lead role on agile scrum teams in various roles, including, but not limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager, or Tester, based upon experience and need.

Provide required business and/or subject matter expertise for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and existing systems. Ensure compliance for required standards and all necessary approvals have been obtained throughout the project lifecycle. Interface with the business areas, customers, partners, vendors, technical staff, and project teams to drive value, return on investments and innovative solutions. This includes providing alternative solutions, including vendor solution acquisitions, with maximum benefits while reducing cost (e.g., cost benefit analysis, pros/cons of solutions). Take lead role in supporting various aspects of requirements testing (e.g., testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts. Communicate in an exemplary manner with team members, customers, partners, and management, including assisting with or conducting requirement walkthroughs and sprint reviews, reporting project status, enabling vendor solutions and providing accurate and concise documentation. Provide thought leadership and strategic direction in Product and Technology Solutions. Other duties as assigned.

**EDUCATION**

**Required**

+ Bachelor's Degree in Business Administration, Business Management, Information Systems, or related field

**Substitutions**

6 years of relevant experience

**Preferred**

+ Bachelor’s Degree

**EXPERIENCE**

**Required**

+ 5 years program management (to include managing programs and leading the teams) or people-leader experience (Manager, Supervisor or Team Lead)

+ 5 years of managing technology-related projects and experience working with operational computer systems

+ 5 years utilizing various industry laws and regulations

**Preferred**

+ 5 years extensive insurance product knowledge

+ 5 years’ experience in workforce development and resource management

+ 5 years with business process improvement

+ Experience with Altruista/Guiding Care

+ Hands on configuration experience

+ Experience working in a SaaS model

+ Medicaid Knowledge

+ Agile

**LICENSES or CERTIFICATIONS**

**Required**

+ None

**Preferred**

+ PMP

**SKILLS**

+ Ability to relate to all levels of management and staff as well as external customers.

+ Experience evaluating technology for implementation in gaining improved services

+ Experience in reengineering processes and procedures to achieve costs reductions

+ Strong business writing and oral communication skills.

+ Excellent team building and professional development skills.

+ Advanced negotiation and influencing skills.

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc\_self\_print\_poster.pdf )

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

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Req ID: J177031

Bismarck, North Dakota

Invest in yourself by becoming part of the Highmark Health enterprise! Build and grow your career with the tools and resources you need to be successful in our innovative and transformational environment. From new hire training to advanced education opportunities, career planning is a continuous journey that leads to your personal and professional growth and our success.

Whether your focus is nursing, information technology, actuarial, finance, marketing, sales, operations or one of our many other professions, our companies offer opportunities to develop and expand your career while making health care accessible, understandable and affordable for our millions of members, patients and customers.

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