Associate Document Implementation Analyst Highmark IncAssociate Document Implementation AnalystPARemoteWorking under general guidance, the Associate Document Implementation Analyst develops proficiency in operational processes, digital tools (including supported applications and system integrations), and compliance requirements. 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.
Senior Case Manager RN - Oncology (Remote) Highmark IncSenior Case Manager RN - Oncology (Remote)PARemoteThe Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services. 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.
Customer Service Representative II, (Temporary-Remote) MaximusCustomer Service Representative II, (Temporary-Remote)Pittsburgh, PARemoteFull timeEssential Duties and Responsibilities: - Provides customer service for basic and routine inquiries and problems via multiple possible channels (i.e. telephone, emails, web chats, or written letters). This is a bring your own device position which requires you to provide your own Smart Phone, personal computer, webcam, & headset with microphone (Tablets, iPads, and Chromebooks are not permitted.).
Director Digital Product Management Highmark IncDirector Digital Product ManagementPARemoteDemonstrated ability to work with minimal supervision with a high degree of organization and attention to detail; manage multiple simultaneous tasks, assignments, deadlines, and produce results, and be results-oriented team player who leads by example, holds self-accountable for performance, takes ownership, and champions all aspects product initiatives. Ability to lead and influence others within a matrixed organization, and leads with a true sense of urgency with the ability to engage the workforce to do the right thing every time for our customers and clinicians; Leads with a customer and clinician-centric lens and advocates for a combined customer and clinician view in all interactions.
Manager, Product Management, Member Interaction & Engagement Data Highmark IncManager, Product Management, Member Interaction & Engagement DataPARemoteThis role also requires demonstrated experience leveraging member engagement and interaction history data sourced from hybrid channels (voice, text, digital, print, etc.), coupled with robust data management and data product expertise, to drive personalization, improve administrative efficiency, and facilitate seamless omnichannel experiences across the organization. A core component of this role includes the ability to ideate and sequence innovative data products, build comprehensive data needs roadmaps aligned with business objectives, and rigorously evaluate data quality, accuracy, and availability requirements.
Supervisor Appeals - Medicare (Remote) in PA or DE Highmark IncSupervisor Appeals - Medicare (Remote) in PA or DEPARemoteThe incumbent is responsible for the direct oversight and/or technical direction of non-clinical staff that make determinations to pay or deny services, identify provider education opportunities, and appropriate referrals to other contractors (Program Safeguard Contractor (PSC) for potential fraud and abuse activities, Qualified Independent Contractor (QIC) for second level appeals, etc…). 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.
NewAccount Manager - CarepathRx - Remote The Cigna GroupAccount Manager - CarepathRx - RemotePARemoteThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. In this role, you will build strong referral relationships, coordinate complex home-care services, and partner with clinical and operational teams to deliver seamless, cost-effective care and a positive patient experience.
NewSpecialist Case Manager RN - (Remote) Highmark IncSpecialist Case Manager RN - (Remote)PARemoteMaintain oversight over specified panel of members by performing ongoing assessment of members" health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services.
NewTransformation Manager Highmark IncTransformation ManagerPARemoteThis job serves as the delivery leader responsible for defining, owning, and delivering mid-size engagements designed to meet/exceed key performance metrics (e.g., admin cost reduction, process improvement, automation, medical cost/value improvement, and enhanced customer/provider experience) for specific clients within the organization. Delivery Responsibilities: Lead individuals, teams or multiple groups and play an active role in analyzing project goals, creating a plan to achieve those goals, and helping to drive the consulting team members, client stakeholders/SMEs and potentially other third parties to achieve those goals while understanding the client environment and any limitations to execution.
Finance Technology Product and Portfolio Lead Highmark IncFinance Technology Product and Portfolio LeadPARemoteStakeholder Management & Communication: Exceptional ability to engage, influence, and communicate effectively with diverse stakeholders, including senior leadership, finance business partners, and technology teams. 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.
NewPharmacist - Case and Disease Management (CMDM) - Remote Highmark IncPharmacist - Case and Disease Management (CMDM) - RemotePARemoteIn 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. Contact patients, care givers, physicians, pharmacists, etc. to intervene on identified gaps of care using a high level of clinical judgement and discretion.
NewAccount Manager Associate - CarepathRx - Remote The Cigna GroupAccount Manager Associate - CarepathRx - RemotePARemote$17.75–$19 / hourThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Construction Specialist - Municipal & Water/Wastewater HRGConstruction Specialist - Municipal & Water/WastewaterCranberry Township, PennsylvaniaRemoteOur founders set out to create an enjoyable workplace, and their vision continues today with regular potlucks, picnic lunches, team building retreats, and friendly games. Construction Specialist - Municipal & Water/Wastewater At HRG , we pride ourselves on being an employee-owned, nationally recognized consulting engineering, planning, and infrastructure solutions firm.
Project Manager | Water & Wastewater HRGProject Manager | Water & WastewaterCranberry Township, PennsylvaniaRemoteYou will lead multidisciplinary project teams, coordinate resources, and serve as the primary point of contact for clients, stakeholders, and internal team members throughout all phases of project delivery. Our founders set out to create an enjoyable workplace, and their vision continues today with regular potlucks, picnic lunches, team building retreats, and friendly games.
Senior Project Manager | Transportation HRGSenior Project Manager | TransportationCranberry Township, PennsylvaniaRemoteThis role provides technical and strategic leadership for multidisciplinary project teams while maintaining responsibility for project scope, schedule, budget, quality, and regulatory compliance. Our founders set out to create an enjoyable workplace, and their vision continues today with regular potlucks, picnic lunches, team building retreats, and friendly games.
Senior Project Manager | Water & Wastewater HRGSenior Project Manager | Water & WastewaterCranberry Township, PennsylvaniaRemoteOur founders set out to create an enjoyable workplace, and their vision continues today with regular potlucks, picnic lunches, team building retreats, and friendly games. 100% Employee Ownership: Every member of the team shares in the firm’s financial success through the company-funded employee stock ownership plan (ESOP), but ownership means so much more to us at HRG.
Project Manager | Municipal & Water Resources HRGProject Manager | Municipal & Water ResourcesCranberry Township, PennsylvaniaRemoteDemonstrated experience in municipal representation, stormwater management, roads, utilities, construction administration, ordinance and plan review, environmental permits (PADEP, USACE, FEMA), PennDOT permits, grant applications, project presentations, specification writing, and meeting facilitation preferred. You will lead multidisciplinary project teams, coordinate resources, and serve as the primary point of contact for clients, stakeholders, and internal team members throughout all phases of project delivery.
VP Reserving Forecasting & Trend Analytics Highmark IncVP Reserving Forecasting & Trend AnalyticsPARemoteStrategic Actuarial & Financial Leadership: Serve as a trusted advisor to Senior Management and cross-functional teams, proactively identifying opportunities and advocating for strategic and tactical changes and best practices that align with Highmark"s enterprise-wide goals. Advanced Trend Analytics & Insights: Lead and empower the Trend Analytics team to identify, analyze, and interpret key trend drivers, developing early indicators that inform medical economics strategies and support proactive intervention.
NewMedical Case Manager - Remote (Pennsylvania) Highmark IncMedical Case Manager - Remote (Pennsylvania)PARemoteLicensed Social Worker (LSW)-Non-Specific - State (OR) Licensed Professional Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors Social Worker (LBSW) (OR) Licensed Clinical Social Worker (LCSW) - Non-Specific (OR) Licensed Master Social Worker (LMSW) Non-Specific (OR) Licensed Graduate Social Worker (LGSW) (OR) Licensed Certified Social Worker (LCSW) (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services.
Coder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus Eligible Highmark IncCoder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus EligiblePARemoteIn 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. GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days.