229 data security jobs found in Des Moines

Company : Highmark Health Job Description : JOB SUMMARY This job plays a critical role representing the customer's voice throughout the product development lifecycle. Will establish and evangelize the vision and strategy for assigned digital products, clearly articulate the "why" behind the products, and own the digital product roadmap. Will bridge technology, business, and customer needs to create remarkable digital experiences that solve customer's problems, drive business value, and produce desired outcomes. Wiill be responsible to define the product's fundamental value proposition, outline the vision and execution plan, gain alignment and support from key strategic partners and stakeholders, and oversee execution of that vision. The incumbent will collaborate with digital design, digital development, and data & analytics counterparts to align and coordinate efforts for effective delivery. This role is looking for someone who has payor or provider...

Company : Highmark Health Job Description : JOB SUMMARY This job supports one or more analytical aspects of the product management lifecycle, within a sub-product scope (one or more business application components). Uses regular judgement and discretion to collaborate with customers and business stakeholders in order to: Understand customer and stakeholder needs, business capability needs; Identity opportunities and create business cases and cost sheet analysis to support the product strategy and evolve the product roadmap; Translate high-level business needs into detailed business requirements for new / modified business capabilities; Perform research, analyze data to determine business problems and trends, assess business processes and business rules to identify/recommend opportunities for process improvements and / or recommendation new / modified business capabilities; Work with business stakeholders and delivery partners to prioritize business capabilities in...

Company : Highmark Inc. Job Description : JOB SUMMARY This job supports the growth of the Organization's sales goals through the development of customer-focused, strategically-positioned sales messaging. The incumbent is responsible for the development, coordination, and timely response to complex RFIs/RFPs in support of local, mid-market and national sales objectives for current and prospective customers across multiple lines of business. Assists in determining the appropriate products, strategies and unique customized solutions to meet a customer's specific needs. Consults, engages and communicates effectively with all levels of the Organization, including executive management to write professional and persuasive proposals, executive summaries, white papers (through strategic research, market analysis and creative resources) for external clients, consultants, Partner Plans. Fully accountable and overall responsibility of projects end-to-end and ensures final...

Company : Highmark Health Job Description : JOB SUMMARY This role is critical for defining the fundamental value proposition of our product, outlining its vision, and creating a comprehensive execution plan. The incumbent will be responsible for gaining alignment and support from key strategic partners and stakeholders, and overseeing the execution of that vision. A core responsibility will be attending sprint/milestone reviews with the Delivery team to ensure successful implementation. This individual will be instrumental in creating the roadmap for the types of clinical data brought into the organization, establishing these data assets as the single source of truth for clinical information across the enterprise. We are seeking a professional with a strong background and deep understanding of the healthcare industry. This role can be hybrid or remote, would prefer East Coast or Central time zones . ESSENTIAL RESPONSIBILITIES Understand the...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for supervising member service call center and ensuring timely, professional, and courteous responses to all customer inquiries and complaints, appropriately referring inquiries to other areas as necessary for resolution. Investigate escalated member inquiries. The incumbent may be required to make routine medical approval decisions. ESSENTIAL RESPONSIBILITIES Manage the departmental operations and day-to-day functions. Handle escalated calls from members, state agencies, providers and vendors. Coach and counsel employees. Prepare reports for various internal and external areas for trends and statistics. Create and maintain quality and training programs for department. Responsible for on-call emergency contact for nights and weekend support. Other duties as assigned or requested. QUALIFICATIONS Minimum High School Education or...

Company : enGen Job Description : JOB SUMMARY This role will specifically guide the definition and delivery of capabilities related to the Epic Payer Platform and other EHR vendor interoperability solutions, focusing on enabling efficient payer-provider and payer-payer healthcare data exchange. The role will be part of the enGen data organization. The Senior Product Owner is responsible for leading and guiding a cross-functional team in the development and delivery of high-quality technology products. The ideal candidate will have a strong understanding of technology concepts and practices, agile methodology, product development, and the healthcare industry. They will be responsible for defining product vision, strategy, and roadmap, managing the product backlog, and ensuring successful product launches. They will also mentor other Product Owners, collaborate with stakeholders, and communicate product updates to leadership. This is a highly collaborative role...

Company : Highmark Health Job Description : JOB SUMMARY The Senior Strategy Partner plays a critical role in driving the evolution and optimization of Highmark's Living Health Acceleration operating model. This individual will be instrumental in continuously enhancing the product operating model within PHE and with critical partners, ensuring it aligns with strategic goals and market demands. The Senior Strategy Partner will bring an external perspective on operating model and workforce optimization for the Product organization, collating and subsequently leveraging data to inform decision-making to enhance operating model performance and maturity. This role also encompasses leading strategic communications, managing leadership meetings, and spearheading special projects on behalf of the Product organization and leadership team, to advance the organization's goals and priorities. This role can be hybrid or remote - if you are within 50 miles of an office you are...

Company : Highmark Inc. Job Description : JOB SUMMARY This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting. 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...

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Company : Highmark Health Job Description : JOB SUMMARY This role is responsible for supporting the execution of member activation and engagement initiatives across products and solutions, with a particular focus on the clinical side of the business. As part of the Customer Relationship Management (CRM) team, this individual will contribute to developing a center of excellence for creating and managing profitable customer relationships and experiences. Key responsibilities include developing end-to-end strategies that will help with managing relationships with clinical partners, identifying C2V savings, overseeing wellness programs, addressing diagnosis and care gaps, and promoting member health through education and preventative steps. Preferred experience as a clinician or in a clinical setting. This role can be hybrid or remote. If you live with 50 miles of an office you are required to be onsite 3 days a week (T,W,Th). Outside of 50 miles will be remote....

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides expertise for moderately to very complex problem solving and complete understanding of system functionality. The incumbent reviews significant amounts of data and analyzes processes to support business unit needs. Troubleshoots errors, conducts impact analyses, and/or solves data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. Provides guidance and education to Associate and Intermediate level employees. ESSENTIAL RESPONSIBILITIES Intake operational objectives and gather information. Define, understand, and manage project scope. Perform moderate/complex research to support evaluation of complex output requirements and formats. May translate more complex business initiatives to less experienced employees. Present project deliverables to appropriate audiences. Create reports on...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides personalized support and guidance to customers through an omni-channel experience, leveraging knowledge of healthcare administration and integrated partnerships to proactively resolve inquiries, ensuring a positive and seamless experience and ultimately driving positive member behavior and cost-effective business outcomes. ESSENTIAL RESPONSIBILITIES Serve as the primary point of contact for customers seeking information and assistance regarding their health benefits, claims, and online healthcare tools. Resolves standard and frequently non-routine, customer inquiries, comments, and concerns with the most limited escalation consistent with company policies and processes. Engage and guide members through clinical model complexities; connect members with appropriate clinical and non-clinical resources and redirect member site of care as defined by model and client requirements....

Company : Highmark Inc. Job Description : JOB SUMMARY This position coordinates member and provider outreach activities. The role focuses on completing non-clinical tasks, including prescriber office outreach, benefits investigations, and formulary research to ensure timely, accurate information gathering and communication. ESSENTIAL RESPONSIBILITIES Conducts member outreach in a professional, courteous, and service-focused manner, gathers and verifies, patient information prior to transferring cases to a pharmacist, ensuring completeness and accuracy. Supports timely processing of requests by following established workflows, turnaround time expectations, and regulatory requirements. Performs prescriber office outreach to initiate changes, obtain documentation, clarify medication information, and resolve non-clinical case needs. Completes benefits investigations, including eligibility verification, formulary coverage clarification, and...

Company : Highmark Inc. Job Description : JOB SUMMARY The job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. This incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/ savings of money related to fraud, waste and abuse. The incumbent must be able to testify in a court of law, prepare cases for referral to...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. ESSENTIAL RESPONSIBILITIES Communicate effectively with physician and pharmacy network providers to ensure that the needs of the...

Company : enGen Job Description : JOB SUMMARY This pivotal role will lead the strategic transformation and optimization of workforce operations across enGen, encompassing both internal resources and external vendors. The Senior Director will be a key driver in establishing robust frameworks for tracking hours, managing financial allocations, and ensuring highly efficient resource deployment. This individual will possess a deep understanding of transformational initiatives, serving as a change expert who can intelligently engage with vendors, internal stakeholders, and senior leadership to align business operations with strategic objectives and deliver significant value. This leadership role is responsible for influencing, shaping, and executing high-impact strategies and initiatives delivering significant enterprise-level value. The Senior Director level demands a high degree of strategic leadership, independent decision-making, and accountability for fostering...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for each grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties involved in the case the investigation results. ESSENTIAL RESPONSIBILITIES Review inquiries to determine if they meet definition of appeal/grievance. Request and review all related relevant documentation and assemble case file. Coordinate resolution results and relay investigative results with all involved parties. Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross...

Company : Highmark Inc. Job Description : JOB SUMMARY This job resolves standard and occasional non-standard customer inquiries, comments, and concerns by applying a seamless and positive customer experience gained through many recurring cycles of on the job work engagement. ESSENTIAL RESPONSIBILITIES Engages with customers in a confident and compelling manner, performing the full range of customer service duties and responsibilities, as assigned. Strives to resolve customer concerns in a single interaction via telephone, written, or face to face communication. Responds to a diverse set of customers with an equal level of confidence regardless of the issue at hand. Works independently of support from a senior customer service representative, frequently utilizing the knowledge center, answering customer inquiries. Routinely responds to customers with an in-depth product knowledge achieved through a continuously improving set of...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Company : Highmark Health Job Description : JOB SUMMARY This job is a senior level actuarial analyst position. Participates in Highmark's Actuarial Executive Development Program and is expected to make continued progress towards actuarial credential. Utilizes experience and industry knowledge to define & diagnose a problem, outline data requirements for a study or analysis, and devise potential solutions. Guides and mentors less experienced staff and provides decision support to team members while initiating and leading the development of actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers and making appropriate recommendations to management. Will work to develop efficient processes and will apply actuarial techniques and statistical analysis to several functions which may include insurance premium and pricing development, claim trend analysis, experience studies, medical economics, profitability analysis,...

If you are a Business Development or Key Account professional looking to take the next step in your career, Emerson has an exciting fully remote opportunity available within the continental United States. While the role can be based anywhere nationwide, there is a preference for candidates located on the East Coast or Midwest due to the concentration of customers within the Industrial Segment. As the Industrial Sales Manager, you will build strong, strategic relationships with key stakeholders across the industrial market. You will serve as a trusted partner and customer advocate-both externally with clients and internally across Emerson-by developing a deep understanding of customer priorities and aligning Emerson's solutions to help them achieve their goals. This is a high-impact role ideal for someone who excels at cultivating partnerships, driving growth, and representing the voice of the customer. In This Role, Your Responsibilities Will Be: Carry out industrial...

The Medical Director, Global Medical Strategy (Rheumatology & Dermatology Pipeline) is a critical role responsible for shaping the strategic processes and planning for assets in early development (pre-Phase 3) within the Nephrology and Immunology portfolio. This position manages the unique challenge of?establishing?an emerging portfolio, incorporating newly?acquired?assets, which requires significant scientific and strategic agility and?a?strong?ability to balance competing priorities. This position reports directly to the Senior Medical Director, Global Medical Strategy Franchise Lead. Key Responsibilities Include: ? Medical Strategy & Narrative ? Provide key medical input into the?initial?development of the?Target Reimbursable Product Profile?as well as early development plans ensuring scientific consistency and alignment across R&D, Clinical,?Global?Medical Affairs, and Early Commercialization?functions?? Provide high-quality scientific/clinical...