hmsacareers

Function as a central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions. Investigate and resolve escalated claims and trends, including denied or delayed claims, by coordinating with relevant departments to implement sho

Management of multiple units/teams and staff in multiple locations, fostering a work environment that encourages teamwork, promotes personal growth and learning. Provide leadership and direction to align with HMSA strategic initiatives and mission, as well as best practices in the industry. Provide

Responsible for providing support to HMSA's network infrastructure. Responsibilities include, but are not limited to the following: Ensures the reliability of HMSA's networks Maintains and upgrades HMSA's network infrastructure. Updates configuration management tools, and documents procedures and co

Responsible for operating and providing support to HMSA's network infrastructure. Responsibilities include, but are not limited to the following: Ensures the reliability of HMSA's networks, to include the planning and implementation of enhancements. Implements, maintains and upgrades HMSA's network

Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established standards that support HMSA's ability to comply with customer performance requirements, while receiving and responding to inquiries. Conduct res

Oversee daily cash positioning, concentration, and funding/settlement across HMSA legal entities. Support oversight of corporate banking and financial institution relationships, primarily related to treasury, cash management, and settlement operations. Execute and approve wires, ACH, and EFT payment

Business & Requirements Analysis Collaborate closely with business stakeholders, product owners, business analysts, and subject matter experts to understand business processes and requirements. Facilitate requirement review sessions to identify ambiguities, gaps, and testability concerns. Translate

Manages community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery, resiliency, and wellness. Advocate and support members and their families by prioritizing their needs and preferences, making sure they receive appro

Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes determination of inpatient hospital stays as medic

Successfully progress through and complete on-the-job training to respond verbally, in person and in writing to internal and external customer's inquiries on enrollment, eligibility, benefits and claims adjudication questions in a professional, accurate and timely manner. Review, assess and deliver

Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established standards that support HMSA's ability to comply with customer performance requirements, while receiving and responding to inquiries. Conduct res

Product Strategy & Portfolio Management Own the end to end product strategy for the assigned segment, including benefit design, competitive positioning, rate considerations, and portfolio optimization. Establish short and long term product goals in partnership with leadership; translate strategy int

Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and IT leadership to develop multi‑year category strategies for IT & Technology Operations vendors. Lead execution of IT vendor strategy, ensuring alignment with enterprise architecture, digital transformation, and cyber

Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and operations leadership to develop multi-year category strategies for Healthcare operations vendors. Lead execution of operations vendor strategy, ensuring alignment with enterprise architecture, digital transformation

Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as assigned by management independently. Independently be able to ensure Provider Operations' needs are addressed; must be able to clearly artic

Conduct open enrollment benefit presentations (second sale), handle current and prospective member inquiries, and support benefit/health fairs at employer sites on Oahu and the Neighbor Island (in-person and/orvirtual). Strategically plan, staff, coordinate, and organize seminars/workshops to drive

Data Management: Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, goes back to source if problems are found, and identifies other options/alternatives if

Manage community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery, resiliency, and wellness. Advocate and support members and their families by prioritizing their needs and preferences, making sure they receive approp

Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs Lead and implement internal controls; facilitate definition of data and other information requirements; define efficient data assembly methods; and mainta

Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program/plan cost and utilization. Analyze data and identify trends, patterns, or other not