Director of Rating Tools Enablement

Company :

Job Description : 

JOB SUMMARY

Highmark seeks a Director of Rating Tools Enablement to lead the design, development, and maintenance of our critical technology platforms supporting underwriting and actuarial rating functions.  This role is pivotal in ensuring the ongoing success and scalability of our key systems, including OASIS (Opportunity Assessment Solution Impact System), BeRT (Benefit Richness Tool), and PUMA (Powerful Underwriting and Modeling Analytics), which are instrumental in driving revenue growth and operational efficiency. The successful candidate will leverage strong leadership and technical expertise to manage a team, oversee projects, and collaborate effectively with various stakeholders across Underwriting, Actuarial, Sales, and IT.  The focus will be on ensuring these tools accurately and efficiently support the rating process, enabling rapid response to market demands and contributing significantly to Highmark's bottom line.
 

ESSENTIAL RESPONSIBILITIES

• 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.
• Oversee the execution of analytics to support the implementation of key medical cost savings initiatives: Understand the insights required to capture cost-savings, Design user-friendly tools that integrate into required business workflows, Rapidly design and deploy the analytics to the key functional areas and Partner with Finance to track impact.
• Ensure products are managed to Agile best practices (roadmaps, backlogs, release cycles, quality testing), and fully integrated with insights from the rest of Advanced Analytics and ED&A.  
• Lead in a matrixed work environment: Influence other departments where you do not have direct authority, Help drive a culture change from “reporting the past” to “creating the solutions for future”, Be persistent in following up with senior management and staff from numerous departments, Collaborate with P&L owners and functional leaders. This will require strong communication skills (verbal and executive quality presentations) and Be able to determine when projections seem unreasonable and constructively push back until satisfied with the analysis.
• Other duties as assigned or requested.

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Additional Responsibilities:

Strategic Leadership & Platform Management: Develop and execute the technology roadmap for underwriting and actuarial rating systems, prioritizing initiatives aligned with Highmark's strategic goals.  This includes ongoing maintenance, enhancement, and evolution of OASIS, BeRT, and PUMA, along with future platform development focused on rating accuracy and speed.

Team Leadership & Management:  Lead and mentor a high-performing team of analysts, software engineers, and other technology professionals. This includes talent acquisition, performance management, and career development.

Project Management & Delivery: Oversee the entire project lifecycle for technology initiatives, from conception and design through development, testing, implementation, and ongoing support, adhering to Agile methodologies. Ensure projects are delivered on time, within budget, and meet specified requirements, with a strong emphasis on rating accuracy and efficiency.
Stakeholder Management: Collaborate effectively with key stakeholders across Underwriting, Actuarial, Sales, and IT to gather requirements, manage expectations, and ensure alignment on technology solutions. This involves strong communication, presentation, and influencing skills at all levels of the organization.

Technical Oversight: Provide technical guidance and expertise to the team, ensuring the use of best practices, adherence to security and compliance standards, and the selection of appropriate technologies for accurate and efficient rating calculations.

System Performance & Reliability: Ensure the stability, scalability, and performance of all underwriting and actuarial rating technology platforms, proactively addressing any issues that may arise.  Implement robust monitoring and alerting systems to identify and address potential rating inaccuracies.

Budget Management: Manage the budget for the department, ensuring responsible spending and maximizing return on investment.

Innovation & Continuous Improvement:  Continuously seek opportunities to improve the efficiency, effectiveness, and user experience of our underwriting and actuarial rating systems, incorporating emerging technologies and best practices as appropriate, with a focus on improving rating accuracy, speed, and compliance.

Regulatory Compliance:  Ensure all rating tools and processes adhere to all applicable regulations and compliance requirements.
 

​EDUCATION

Required

• Bachelor’s Degree in STEM, Analytics, Health Services Research, or closely related discipline

Preferred

• Bachelor's degree in Computer Science, Engineering, or a related field; advanced degree preferred.
   

EXPERIENCE

Required

• 10 years in Advanced Statistical Analysis

• 5 years in Management and/or Leadership role

• 3 years in Consulting and/or working with Senior Leaders

Preferred

• Extensive experience (10+ years) in technology leadership roles, with a proven track record of successfully managing complex technology projects within the insurance or financial services industry.

• Deep understanding of software development lifecycles, Agile methodologies, and project management principles.

• Experience with data analysis, modeling, and visualization tools, specifically applied to actuarial and underwriting rating calculations.

• Proven ability to lead and mentor high-performing teams.

• Strong communication, interpersonal, and presentation skills.

• Strong understanding of actuarial principles and insurance rating methodologies is highly preferred.

• Expert knowledge of software development best practices.
  Proven experience with cloud-based technologies (e.g., AWS, Azure, GCP).

• Experience with data warehousing and business intelligence tools.

• Ability to translate business requirements (especially those related to rating) into technical specifications.

• Excellent problem-solving and analytical skills.

• Understanding of regulatory compliance requirements for insurance rating.

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Data science methods
• Data Science Tools
• Stakeholder Management
• Presentation
• Communication
• People Management
• Project Management
• Python
• Spark
• Artificial Intelligence
• Machine Learning
• Cloud platforms
• Software Engineering

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Languages (other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

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 

No

Lifting: up to 10 pounds

Frequently

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 position 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:

Pay Range Maximum:

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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