Senior Risk and Quality Assurance Analyst

Highmark Health is seeking a Senior Risk and Quality Assurance Analyst in Penbrook, Dauphin County, US. The role focuses on regulator‑required risk and quality assurance studies, supporting Blue Cross Blue Shield Association (BCBSA) initiatives and internal performance metrics.

Key Responsibilities

• Lead and execute risk and quality assurance studies for BCBSA Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program (FEP) projects.
• Collaborate with regulatory bodies, accreditation agencies, executive management, plan partners, and group customers to ensure compliance and continuous improvement.
• Develop, maintain, and analyze performance dashboards and reporting tools for internal and external stakeholders.
• Identify gaps, propose corrective actions, and monitor implementation of quality improvement initiatives.
• Provide expert guidance on risk mitigation strategies and quality standards across the organization.
• Mentor junior analysts and contribute to the development of best‑practice methodologies.

Required Qualifications

• Bachelor’s degree in Health Administration, Business, Statistics, or related field (Master’s preferred).
• 5+ years of experience in risk management, quality assurance, or compliance within the health insurance industry.
• Strong knowledge of BCBSA standards, federal healthcare regulations, and accreditation requirements.
• Proficiency with data analysis tools (e.g., SAS, SQL, Power BI) and advanced Excel.
• Excellent analytical, communication, and stakeholder‑management skills.

Compensation

Salary: $89,090.80 annually (fixed). Additional benefits include health insurance, retirement plans, and professional development opportunities.

Frequently Asked Questions

What certifications are beneficial for this role?

Certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Risk Management Professional (CRMP) are highly valued.

Will I work remotely or on‑site?

The position is based on‑site in Penbrook, Dauphin County, with occasional remote work options as needed.

What growth opportunities does Highmark Health offer?

Highmark Health provides clear career pathways, mentorship programs, and support for advanced education and certifications.