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Highmark Medicare Jobs (NOW HIRING)

Highmark Health

Retail Store Associate - A

Monroeville, PA

$15 - $17.25/hr

Highmark Inc. : JOB SUMMARY This job is responsible for meeting with customers and selling all ... Annual Medicare/CMS Certifications * State specific Producer License for Accident and Health is ...

Highmark Health

Retail Store Associate - A

Monroeville, PA · On-site

$15 - $17.25/hr

Highmark Inc. : JOB SUMMARY This job is responsible for meeting with customers and selling all ... Annual Medicare/CMS Certifications * State specific Producer License for Accident and Health is ...

Highmark Health

Retail Store Manager

Pittsburgh, PA · On-site

Highmark Inc. : JOB SUMMARY This job oversees one Highmark Direct Retail Store. Will work closely ... Complete required training, including Annual Medicare/CMS certification. * Other duties as assigned ...

Highmark Health

Retail Store Manager

Pittsburgh, PA

Highmark Inc. : JOB SUMMARY This job oversees one Highmark Direct Retail Store. Will work closely ... Complete required training, including Annual Medicare/CMS certification. * Other duties as assigned ...

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Highmark Medicare information

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$140.5K

$211.9K

$237K

How much do highmark medicare jobs pay per year?

As of Aug 18, 2026, the average yearly pay for highmark medicare in the United States is $211,935.00, according to ZipRecruiter salary data. Most workers in this role earn between $205,000.00 and $220,000.00 per year, depending on experience, location, and employer.

What is Highmark Medicare?

Highmark Medicare refers to Medicare insurance plans offered by Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark provides a range of Medicare options, including Medicare Advantage, Medicare Supplement, and Medicare Part D prescription drug plans. These plans are designed to help cover healthcare costs that aren't paid by Original Medicare, such as copayments, coinsurance, and prescription drugs. Highmark operates in several states and helps members find coverage that fits their healthcare needs and budget.

What are the typical team dynamics and collaboration opportunities for someone working in a Highmark Medicare role?

In a Highmark Medicare role, you'll typically be part of a multidisciplinary team, which may include case managers, customer service representatives, healthcare providers, and compliance specialists. Collaboration is frequent, as you may need to coordinate care plans, resolve member issues, or interpret policy guidelines with input from various departments. Regular meetings, both virtual and in-person, help ensure everyone is aligned on goals and regulatory updates. This environment fosters professional growth, as you'll learn from colleagues with diverse expertise while contributing your own insights to improve member experiences and outcomes.

What are the key skills and qualifications needed to thrive as a Medicare Specialist at Highmark, and why are they important?

To thrive as a Medicare Specialist at Highmark, you need a solid understanding of Medicare regulations, health insurance products, and customer service principles, typically supported by relevant experience or certifications in health insurance. Familiarity with CRM platforms, Medicare enrollment systems, and regulatory compliance tools is essential. Strong communication, problem-solving, and empathy are crucial soft skills for effectively assisting members and resolving complex issues. These skills and qualifications ensure accurate guidance, regulatory compliance, and high customer satisfaction in a complex healthcare environment.
Highmark Medicare jobs near you
Infographic showing various Highmark Medicare job openings in the United States as of August 2026, with employment types broken down into 5% As Needed, 77% Full Time, 14% Part Time, and 4% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $211,935 per year, or $101.9 per hour.

Medicare Advantage Quality Consultant

Highmark Health

Camp Hill, PA • On-site

Full-time

Posted 7 days ago

Highmark Health rating

7.8

Company rating: 7.8 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

Job description

Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is directly responsible for the value creation, impact and cost control and fiscal/ROI targets as set by the Organization, including revenue stream outcomes, and engagement of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value creation, cost control and utilization, performance, and develops strategic plans in collaboration with PCPs and the inter-departmental teams for transformation of workflows resulting in outstanding performance in government program(s) ensuring that ROI targets set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with other functions in the provider area, data analytics, and key internal/external stake holders to provide the most appropriate support to the PCPs based upon data analysis and dashboard reports.
This is a hybrid based role in Camp Hill, PA or Wilkes Barre, PA.
ESSENTIAL RESPONSIBILITIES
  • Directly responsible to provide office based, hands-on assistance services (i.e., chart reviews, mass claims adjustments, UDC processes, etc.) to PCPs enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines. The Medicare Advantage Quality Consultant is expected to assess the needs of each individual PCP practice, and use a combination of on-site individual office based, entity level based, video conference, teleconference, and electronic mail interactions to drive engagement and exemplary value creation, impact and cost control, and ROI/fiscal outcomes as set by the Organization for government programs.
  • Directly responsible to analyze and interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to meet PCP government program targets to create value, impact, and cost savings, as well as meeting the ROI as identified by the Organization.
  • Directly responsible to assess data for highest ROI opportunities in PCP performance and implement strategic plans to meet identified program targets across all the Organization's value-based programs for both the commercial and government business (ACA, Medicare STARS, Medicaid HEDIS, risk revenue).
  • Function as the Organization's representative subject matter expert in government value-based reimbursement programs and data analysis. This includes presentation of program results to both internal and external audiences, including practice and entity meetings.
  • Participates in the development and presentation of instructional materials for internal and external audiences.
  • Provide assistance to PCPs in the use of user interfaces, predicative analytic tools, and other population health management tools endorsed by Highmark.
  • Independently and autonomously manage PCP caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to transform PCP practices enrolled in government programs using innovative continuous improvement methodologies. This includes cross training in all of Highmark's value-based reimbursement programs to lend support as needed/defined by market outcomes.
  • Serve as the clinical subject matter expert for PCP Medicare STARS, Medicaid HEDIS, and risk revenue programs for both internal and external Highmark key stake holders. In a matrix management environment, works collaboratively with the interdepartmental team to provide the most comprehensive support to PCPs for exemplary scores in government programs.
  • Other duties as assigned or requested.

EDUCATION
Required
  • Bachelor's Degree in a clinical or healthcare related field

Substitutions
  • 6 years of relevant experience in lieu of a Bachelor's Degree

Preferred
  • Master's Degree in a clinical or healthcare related field

LICENSES OR CERTIFICATIONS
Required
  • None

Preferred
  • None

EXPERIENCE
Required
  • 5 years in Medicare/Medicaid and risk revenue, primary care and the ambulatory care environment, healthcare insurance industry government programs, healthcare administration in primary care, or healthcare consulting in government programs for primary care
  • 3 years in data analysis, interpretation, and outcomes strategic plan development
  • Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management

Preferred
  • 7 years in a government program setting, managed care, primary care management or other clinical setting
  • Experience in Lean, Six Sigma, TQI, TQC or other quality management certification
  • Experience in health plan provider network performance management, population health management, continuous improvement or provider engagement models

SKILLS
  • Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authority
  • Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues
  • Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management
  • Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
  • Superior written and verbal communication skills and listening skills
  • Ability to adapt engagement strategies to meet market needs

Travel Requirement
50% - 75%
Language Requirement (other than English)
None
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Position Type
Office-Based
Teaches/Trains others regularly
Constantly
Travels regularly from the office to various work sites or from site-to-site
Frequently
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
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 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 any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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About Highmark Health

Sourced by ZipRecruiter

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

Industry

Health care and social assistance and insurance services

Company size

10,000+ Employees

Headquarters location

Pittsburgh, PA, US

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