Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This key leadership role is responsible for the comprehensive financial oversight and strategic direction of the Health Plan insurance segments within Highmark. The role partners closely with segment leaders and their teams to develop and implement financial strategies that align with their overall business objectives, ensuring the financial health and long-term growth of these critical segments. The Health Plan business segment will generally be comprised of numerous sub-segments and product offerings across multiple states and legal entities.

ESSENTIAL RESPONSIBILITIES

• Team Management: Perform management responsibilities to include but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Foster a culture of collaboration, innovation, and continuous improvement within the finance department, ensuring alignment with the needs of the Health Plan segments and promoting a strong understanding of the health insurance industry. Periodically evaluate the organizational design and operating model of the department to ensure an effective and cost-effective structure, considering the evolving needs of the Health Plan segments.

• Strategic Financial Leadership: Support the development of a comprehensive financial strategy that supports long-term growth and profitability, considering the unique challenges and opportunities within each segment. Provide strategic financial guidance and insights to inform key business decisions, including product development, market expansion, and operational efficiency, with a focus on navigating the evolving healthcare landscape. Analyze industry trends and competitive landscape to identify opportunities and risks, including changes in regulations, market competition, and consumer behavior. Develop and implement financial models and scenarios to assess the impact of strategic initiatives and inform decision-making. Manage the financial aspects of projects over a multi-year horizon, ensuring alignment with long-term strategic goals. Prepare and present financial business case analysis of segment initiatives to senior management for use in the strategic planning process and daily management of the business activities of the segment, then establishing a process and cadence to measure progress towards the business case to ensure value pull through. Direct growth-related economic models for assigned segments and communicate results of strategic impact analyses to senior management. This includes scenario modeling and other integrated economic exercises related to potential changes in reimbursement rates, member volumes, or other financial metrics associated with strategic initiatives and the financial plan.

• Financial Performance Management & Optimization: Oversee the financial operations of multiple business segments within the Health Plan and assess the operating results in terms of costs, budgets, operational policies, trends, and increased profit opportunities. Partner with segment and matrix partner leaders to drive achievement of current year and multi-year financial commitments. Lead segment performance management activities, including the identification and tracking of levers to optimize financial performance. This includes membership growth, claim savings, admin cost savings, buy-up product growth, cross-sell, revenue enhancements and other opportunities. Partner with actuarial functions to enable effective product pricing, appropriate reserving, and accruals. Partner with the admin cost management function to forecast and analyze administrative costs, ensure the appropriateness of cost allocations, and support the achievement of segment/product/region level admin targets.

• Financial Planning & Analysis: Lead the development and execution of annual budgets and financial forecasts for Health Plan segments, ensuring alignment with their strategic goals. Leads the business segment monthly financial analysis process to assess the financial performance of the segments and identify trends, opportunities, and risks, including changes in utilization patterns, claims costs, regulatory requirements, and the cost structure of the business. Develop and present insightful financial reports and presentations to senior management, Board of Directors, and other external stakeholders, highlighting key financial metrics and providing actionable insights. Communicate key assumptions and other planning decisions and corresponding financial outcomes to various levels of financial & segment management.Responsible for forecasting in sufficient detail to analyze progress relative to plan at segment/product/region levels across membership, revenue, claim and administrative expense drivers. Accountable for activities required to maintain financial records, key performance indicators, and analysis of performance relative to them.

• Risk Management, Regulatory & Compliance: Identify, assess, and mitigate financial risks, considering factors such as changes in healthcare policy, economic conditions, and emerging healthcare technologies. Develop and implement internal controls to safeguard company assets and ensure financial integrity, including compliance with regulatory requirements and internal policies. Collaborate with other departments such as Actuarial and Underwriting to manage financial risk across the organization. Support various product filings, resolution of regulatory issues, responses to regulatory inquiries, and provide counseling/advice on regulatory developments, product development issues, and the interpretation and administration of assigned segment products.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 7 years of experience in one or more of the following roles: finance, accounting, actuarial or related role

• 5 years of experience in Management or leadership role

Preferred

• 5 years of Experience in strategic financial planning and analysis role

• Experience within the health insurance industry

• Progressive management experience

SKILLS

• Deep understanding of the health insurance industry, including regulatory landscape, market dynamics, and key financial drivers, specifically with Health Plan segments, including Medicare, Medicaid, commercial and third-party administrators.

• Expertise with financial modeling, forecasting, and budgeting tools, including experience with industry-specific software and platforms.

• Ability to analyze financial results and to comprehend complex rating structures impacting financial results and used for financial forecasting.

• Excellent analytical, problem-solving, and decision-making skills, with the ability to translate complex financial data into actionable insights.

• Proven track record of success in developing and implementing financial strategies that drive business growth and profitability.

• Experience working within a large, matrixed organization, navigating complex reporting structures, and collaborating across multiple departments.

• Strong communication and executive presentation skills, with the ability to effectively communicate complex financial information to both technical and non-technical audiences, including senior management, Board of Directors, and other stakeholders.

• Ability to interact with all levels within the organization with strong assessment and influencing skills.

• Strong leadership and team management skills, with a proven ability to motivate and inspire others, build high-performing teams, and foster a collaborative work environment.

• Must be detail-oriented and possess strong organizational and analytical skills.

EDUCATION

Required

• Bachelor’s degree in Finance, accounting, actuarial science, or another related field or 6 years of relevant experience and/or education as determined by the company in lieu of bachelor's degree.

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• CPA, ASA, or FSA

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel 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

Frequently

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

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 their race, color, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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

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Req ID: J250143