HMSA jobs in Kahului, HI - 156 jobs

Data Management: Reviews data sources and preps needed data. Identifies and communicates issues, limitations, and risks with data sets/reports. 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 problems cannot be resolved. Performs review of data to ensure completeness/accuracy/timeliness for the purpose of the analysis. Maintains tables that are necessary for department or corporate reporting. Ensures existing, approved, corporate tools used can accept/integrate the data. Works with external data contacts to resolve issues related to the delivery or receipt of data. Analytics and Technical Acumen: Performs required analysis, applies accepted statistical methodologies where applicable, and documents the process that was followed, and data sources/tools used. Consults with customers on the appropriate analytical approach, identifies benefits/risks, and makes appropriate suggestions to arrive at the desired outcome. Determines what kind of analytics will be performed (descriptive, predictive, prescriptive) and defines/documents overall framework. Understands various internal and external data sources available; uses expertise to utilize the most appropriate data source. Utilizes appropriate tools to load, integrate, and analyze data. Conducts analysis and documents findings, identifies unexpected anomalies and root cause (if possible) and determines if analysis can continue, identifies alternatives if anomalies cannot be resolved. Ensures reproducibility of outcomes. Documents entire analysis process, including business problem, data sources, methods and tools used, project reference, and outcomes. Implements pre-emptive actions, where possible. Gains the needed skills/knowledge when new technologies arrive and provides translation between old and new. Analytics/Reporting Tool Development & Training: Lead in the development and delivery of analytics/reporting tools for internal and external customers. Types of projects include the development, maintenance, and enhancements of self-service reporting tools and regular or ad hoc reporting. Applies a whole company perspective, draws upon previous knowledge and experience, and -- where necessary -- research new/other approaches to identify and agree upon objectives, approach, and success measures. Gathers customers requirements and translates them into actionable analytics and reporting tools. Defines delivery milestones and negotiates timeframes, monitors progress and periodically notifies customer of status. Provides training to customers on new tools/reporting capabilities Effective Communication: Prepare/present findings that are informative and audience appropriate. Reviews findings and outcomes with customer, ensures business problem/objectives have been met, and prepares documentation of the analysis. Where necessary, manage divergent views in the audience and advises the internal/external customer on any recommendations or options that will facilitate data and analysis driven decision making. Prepares a presentation of the analysis, process followed and reviews it with the customer to ensure the results are audience appropriate. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Lead provider performance management activities. Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement and drive continuous improvement. Oversee and manage staff. Manage the performance governance aspects of provider services contracts. These activities include: Enforce compliance with the contractual SLAs and deliverables. Review and validate performance reporting. Capture potential value leakage and/or service level penalties. Coordinate implementation of SLA reporting automation. Generate dashboards and reports for executive level briefing. Develop and measure provider network performance metrics and objectives, such as: Cost, quality, and accessibility reporting. Network reporting supportive of open enrollment and RFP's. Ensure all regulatory network requirements are measured and reported according to listed requirements, such as: ACA, QUEST, Medicare, HMSA Oversee data analysis functions that support contract negotiations and fee reviews. Oversee out of network provider access strategies including: Single case agreements Network access partner solutions Perform all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Responsible for operating and providing support to various applications within HMSA's infrastructure. Responsibilities include, but are not limited to the following: Analyzes production storage usage and recommends modifications as appropriate (storage). Assists with storage requirements definition and acquisition for projects (storage). Coordinates and implements storage requests, backup schedules, and file restoration activities (storage). Plans, schedules and coordinates implementation of storage and backup solutions (storage). Loads, configures and maintains servers, including assistance with server requirements definition and implementation for projects (server). Analyzes and troubleshoots server problems and issues (server). Plans, schedules and coordinates implementation of server upgrades, patches, and tools (server). Configures and installs desktop PCs, peripheral equipment, laptops and other mobile devices. Performs conversions from desktop to laptop. Coordinates port movement and network access issues. Documents procedures for performing configurations and conversions from desktop to laptop. Provides input regarding port availability, equipment locations, device installations and service during project planning and requirements phase for office moves/adds/ changes. Reviews plans for accuracy. Coordinates the deployment of new images, software/hardware upgrades and fixes. Makes suggestions for design of standard set of integrated products (standard image) by recommending hardware and software products to meet user requirements. Sets up accounts under the local domain and assists with Internet access. Assists external users with dial-up access problems. Coordinates and sets up access or service accounts such as Internet and Email. Is aware of service level agreement targets. Explains service procedures to users. Monitors service level agreements regarding desktops to ensure that requirements are met or exceeded. Escalates problems as required based on SLAs. Informs management as appropriate. Troubleshoots problems. Identifies severity of problem and escalates when necessary. Coordinates with users and other IT resources for problem resolution or works with vendor technical support to resolve client problems. Builds checklists and scripts. Determines if loaner PCs are needed. Updates users on trouble ticket status. Ensures follow up on problems with users. Plans, schedules and performs hardware and software repair and installations. Calls in and coordinates all repairs that deal with outside vendors. Documents problem status and resolution in tracking log. Alerts team members about recurring problems. Provides on-the-spot training to users. Evaluates events log and resolves problems as needed. Administers security procedures. Unlocks or sets passwords as needed. Reports security issues when appropriate. Assists users with desktop recovery issues. Participates in integration testing. May design and lead integration testing. Assists in video conferencing activities. Works with vendors with initial setups and learns procedures. Complies with fixed asset and disposal procedures. Performs system administration functions required for daily operations (server). May research and evaluate software/hardware products and industry trends to assist in project development. Participates in Technical Review Committee (TRC) to ensure enterprise-wide standardization. May define staff schedules and prioritizes work. Provides after business hours support, as needed. Mentors less experienced staff. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

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 appropriate care and services promptly. Conducts screenings for health risks and access barriers, referring to licensed clinicians as needed. Adjust workflows when necessary to provide optimal care for each situation or individual. Uses effective communication techniques, including motivational interviewing, to encourage members to attend regular provider appointments and utilize medical services that support their health. Engage with members and their families to discuss major health concerns and explore solutions to obstacles impacting service delivery, member satisfaction, cost, and community health. These efforts contribute to better care coordination for members overall. Delivers comprehensive education, resources, referrals, and connections to health-related services within the community. Facilitates the introduction of new or underutilized programs and services to community members. Provides guidance to community members facing complex health cases in navigating healthcare systems. Responsibilities may include, but are not limited to, conducting home visits, accompanying individuals to appointments, and supporting community events as needed. Exercises sound professional judgment and adhere strictly to scope and licensure boundaries to ensure actions are taken in the best interest of the community member(s). Provides culturally appropriate health education and instructions on using existing health and social services, presenting information clearly and effectively. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

General Administrative Support Relieves the CEO/assigned Executive(s) of majority of administrative functions and tasks, ensuring the most effective/efficient use of the Executive's attention and focus. Drafts routine and specialized correspondences on behalf of the CEO/assigned Executive(s). Receives, reviews and determines the appropriate parties to channel/direct sensitive, proprietary, and confidential matters to. Actively follows up on the status of pending issues, conducts independent research on subject matters related to Executive's business areas and corporate position, and when appropriate responds independently on behalf of the executive in a timely manner. Responsible for the inventory of supplies on the Executive floor. Internal/External Contacts Coordinates and hosts a variety of internal and external visitors. Receives, escorts, and announces internal/external visitors to the Executive offices. Resolves meeting or event conflicts. Exercises independent judgment when prioritizing communications and determining urgency, escalation needs, and appropriate contact with CEO/assigned Executive(s). Assesses situations and interrupts CEO/assigned Executive(s) schedule for issues/situations that the Executive Assistant determines require immediate action. Answers and routes phone calls appropriately. Meeting/Calendar/Travel Oversees and maintains the calendar for CEO/assigned Executive(s) in highly organized and efficient manner. Evaluates and prioritizes appointments and meetings based on urgency and business impacts, adjusting as needed. Ensures CEO/assigned Executive(s) have an appropriate amount of time to effectively meet various obligations. Books venue(s) for meetings, creates agendas, obtains relevant handouts/brochures, and procures refreshments for the meeting. Maintains a global view of scheduling, efficiently and effectively coordinates with other assistants for meetings that require multiple Executives. Arranges and books complex multi leg itineraries for executive or assigned parties as required. Corporate Communications Monitors and manages the corporate communications channel for CEO/assigned Executive(s). Ensures the timely and accurate flow of information to and from the executive offices including but not limited to marketing initiatives, policy/procedure updates, corporate communications, and any other item that have companywide impact. Prepares and modifies presentations and responses for both internal and external audiences. Acts as a liaison by planning and scheduling across various communication channels to ensure all internal and external parties are well informed. Responds independently to complex matters of significance impacting business goals and outcomes. Special Projects Lead/coordinates internal and external special projects and community engagement activities, simple to complex in nature, based on Corporate goals or initiatives. Researches and evaluates vendors, obtains and reviews RFPs, conducts cost-benefit analysis, negotiates and enters into contracts for products or services on behalf of HMSA ensuring selection of the best vendor/contractor to meet project objective. Efficiently guides vendors/contractors through the Contract Vendor Management (CVM) process. Provides direction and guidance to volunteer staff and external vendors. Also responsible for miscellaneous support tasks during projects/events. Budgeting & Purchasing Reviews and approves purchase orders and invoices within assigned signing powers/levels. Acts as a liaison with various departments to ensure financial, budgeting, and accounting procedures are being followed, and authorizations are obtained. Performs all other miscellaneous responsibilities and duties as assigned or directed.

Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to: Demonstrate understanding and application of over 250 Guide to Benefits, Evidence of Coverage, Plan Brochure, and Member Handbook. HMSA annually updated medical and drug policies, medical protocols, National Comprehensive Cancer Network, Milliman Care Guidelines, Drugdex, etc. to determine the medical necessity of urgent and non-urgent precertification requests. Urgent requests must be completed within 72 hours and non-urgent requests within 15 calendar days. Use clinical judgment, medical necessity guidelines and plan benefits to determine approval, potential denial or alternative treatment of each urgent or non-urgent precertification request. Settings include inpatient, outpatient, in-state, out-of state and out-of country. Document clinical case summary and review outcome of each review appropriately to meet regulatory and program requirements. Review various types of services, including but not limited to: Transplants Air Ambulance Chemotherapy Clinical trials Genetic testing Cancer treatments/radiation therapy Experimental/Investigational Services/Devices New Technology Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to: Call providers when additional clinical information is required to clarify or complete a complex precertification determination. Approve precertification requests based on clinical judgment using criteria, medical record documentation and other information received from the provider. Consult with Medical Directors on requests which do not meet clinical criteria and offer alternative covered health care options as appropriate. Consult Medical Directors on potential quality issues identified during review of medical records. Refer cases to Integrated Health Management, Pharmacy Department or Benefits Integrity Department depending on the concern. Evaluate suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc. Communicate timely, accurate information either verbally, electronically or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to providers, members as well as internal MM staff and other internal departments (Claims Administration, Customer Relations, Provider Contracting, etc.). For denied services, ensure the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation and regulatory guidelines. Identify and refer members with specific medical and/or behavioral health needs or complex case management and collaborate with medical and behavioral case management staff. Identify and refer quality of care issues and suspected fraud, waste or abuse to the appropriate departments. Perform pre-screening assessment of incoming pre-certification requests to ensure appropriateness of review. Advises non-clinical staff on clinical and coding questions to ensure correct system processes and entries. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Responsible for managing all aspects of the planning, execution, controlling, and closure of projects/programs. Responsibilities include, but are not limited to, the following: Receives high-level business requirements and develops detailed requirements. Prioritizes efforts and maintains and manages inter and intra project dependencies. Refines resource requirements and forms project teams. Further defines estimates for financial, physical or human resources to support long-term projects and programs. Champions the development of best practices, project standards, procedures and quality objectives across multiple projects/programs and organizations. Utilizes established project standards, procedures and quality objectives. Conducts project kickoff meetings, communicating individual roles and project/program expectations and ensuring that all project team members have the tools and training required to perform effectively. Integrates detailed project plans and schedules into a master program plan. Provides work direction and leadership to assigned programs, including scheduling, assignment of work and review of individual project efforts. May manage project/product leads. As needed, facilitates the evaluation, selection and contract negotiation for external vendors and independent contractors. Manages relationship with external vendors working to support project requirements. Assesses performance against project milestones/schedule, metrics, scope, quality as defined by contract specifications. Acts as liaison between business client and vendor. Makes presentations to solicit program buy-in, report on project status, conduct problem resolution and other types of communication to a variety of audiences. Monitors program milestones and critical dates, scopes, cost and quality to identify potential risks. Initiates ways to resolve schedule and other project-related issues. Keeps management aware of the situation. Manages any effects on related projects. Assesses variances from the program and project plans, integrates metrics, and develops and implements changes as necessary to ensure that the project remains within specified scope and is within time, cost and quality objectives. Ensures that business owner and/or project executive sponsor has a process to track outcome and satisfaction metrics. Manages effects on related projects. Conducts project review and closure at project completion to confirm acceptance and satisfaction of the program and each related project. Continuously provides the team with constructive feedback as it pertains to project or overall program performance. Works with development team to integrate areas of improvement into the systems development life cycle and project management processes. Develops and maintains a productive working relationship with program stakeholders. Coaches or mentors less experienced personnel. May conduct performance reviews and career planning sessions. Performs other duties as assigned. One example of this would be to personally manage projects when such a need arises. #LI-Hybrid

Accurately calculate and analyze a variety of employer group rates using the historical utilization of the account. Extract and analyze historical data of the account to ensure accuracy and good logic. Analyze the overall composition of the group to ensure that the total risk is not excessive. Produce and audit rate renewals, rate filing worksheets, and exhibits for moderately complex to very complex accounts using pre-established guidelines and templates as a basis for analysis, performing necessary additional research on issues that fall outside these guidelines. Will modify guidelines and templates as needed. Answer complex underwriting questions from accounts and Marketing Department on rate renewal calculations and various financial arrangements. Provide consultation to Account Management and Sales and explain rationale and rating practices for highly complex accounts to assist in rate renewal process. Collaborating with the Underwriting team and account management team to ensure rates and financial options are appropriate. Accurately prepare, analyze, and audit other reports as required by account (5500, utilization reports, financial reports, financial accountings, financial statements, etc.). Prepare, analyze, and reconcile monthly billings for self-insured accounts based on the terms of the contract with the account. Answer moderately complex to complex underwriting questions from Account Management and Sales Department on statistical and financial reports. Produce and audit other data as needed to support the Account Planning process. Analyze and prepare rate proposals for prospective accounts based on information provided and recommend best course of action. May accompany Account Management and Sales staff to client meetings to answer questions and provide additional underwriting information when needed. Update and maintain rating and reporting system. Research and resolve data problems when they arise. Identify, research, track, and report paid/unpaid case amounts as needed. Prepare and audit monthly recovery reports with supporting documentation and respond timely to open queries. Aggregating and organizing data submissions and narratives for reinsurance audits and reinsurance renewal submissions. Deliver training and coaching to other underwriting colleagues. Leading input on efforts to support best practices for the department and HMSA. Participate in special projects. Perform all other miscellaneous duties and responsibilities as directed or assigned. #LI-Hybrid

Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, and accreditation standards. Develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance. Collaborate with external partners, IT, Claims Operations, Provider Services, Compliance, and Product teams to ensure system configurations support new products, regulatory changes, and organizational initiatives. Lead testing, validation, and sign-off processes for new configurations, system upgrades, and change requests Drive process improvements and automation opportunities to enhance configuration efficiency and reduce errors. Serve as a subject matter expert (SME) for configuration management, providing training, guidance, and mentorship to internal and external team members and business stakeholders. Performs all other miscellaneous responsibilities and duties as assigned or directed.

Recommends competitive and sustainable pricing for products based on actuarial models and market trends Leads product updates, maintains competitiveness and addresses customer needs throughout the product lifecycle Develops and implements data quality control procedures for actuarial performance data Collaborates with stakeholders to define the product vision and roadmap for future development Manages relationships with third-party vendors for product development Champions new methods for data visualization to effectively display actuarial product advantages and benefits #LI-Hybrid

Independently process group and direct payments received from walk-in members and groups while providing all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Effectively and independently analyze and research inquiries from customers (internal and external) relating to billing and payments processed by cashiers. Handle customer inquiries (internal and external) by responding to their needs quickly and efficiently. Requires broad understanding of HMSA's business, including the Hawaii Health Connector, HMSA online storefront, LRSP, QNXT, and ancillary systems. Provide quality service in line with HMSA's mission and vision. Assist in bill production for individual subscribers and groups, including cycle billing and demand billing. Performs reconciliations and audits to ensure the billing system, A/R system, and electronic bill presentment system are in balance. Independently resolves any identified variances. Process mailed-in group and direct payments from members and groups. Process rejected and unprocessed payments from Bank of Hawaii Lockbox. Process miscellaneous payments from other departments: Medicaid, Workshops, Administrative Services Only, Long Term Care, etc. Process medical refund checks (HMSA or other) mailed-in by members and providers. Process miscellaneous checks from Finance & Accounting units. Process member Automatic Dues Payment Set-up (DPS) and mailing notification letters. Process QNXT Unapplied Cash Payments. Balance and reconcile deposits, and record payments to various general ledger accounts. Review and conduct analyses to assist the department in maintaining an efficient delinquency and cancellation process for individual subscribers and groups. Includes monitoring delinquent subscribers and groups, generating and mailing delinquency and cancellation letters, and ensuring that cancelled accounts are reconciled accurately. Process routine enrollment and group or subscriber maintenance transactions submitted in the HMSA Centers. Processes returned checks, agent fee bills, and issues petty cash. Balance cash daily and replenish till monthly. Record expenses to proper operating expense general ledger account. Make corrections as needed. Performs all other miscellaneous responsibilities and duties as assigned or directed

Monitor and analyze regulatory/accreditation/business requirements to invoke recommendations for program and/or policy changes as appropriate for various lines of business. Lead/coordinate activities, which include internal audits, quality assurance control, quality improvement, provider satisfaction and department policies and procedures, to meet and/or maintain regulatory/accreditation/line of business requirements. Serve as a resource to internal and external staff regarding issues relating to administrative policies and procedures, medical policies, and researching and resolving problems. Edit all documentation generated by unit e.g., QIAs, reports, executive summaries, presentation materials, workplans, evaluations, annual plans, policies and procedures, minutes, agendas, provide feedback, and develop/generate monitoring reports/tools. Coordinate/schedule training opportunities and develop/present related reports and various documentation. Coordinate, support and document various department activities to ensure deliverables are completed by due date. Perform other duties (e.g., attend meetings) as assigned. #LI-Hybrid

Analyzes encounter system processes within HMSA and external partners. Coordinates and reconciles exchange of data with external entities. Researches various claim-member-provider scenarios to determine root cause of data submission errors. Participates in discussions with internal staff to optimize encounter submission processes. Participates in projects to increase the scope or efficacy of encounters submission. Provides data to support financial reporting. Monitors government/vendor requirements changes. Ensures submission methodologies are compliant with published guidance. Documents new processes or procedures and updates existing documentation.

Manage staff, ensuring provider inquiries are responded to timely, accurately, and professionally. Resolve complex provider inquiries. Respond to and oversee staff responding to CMS demand letters. Participate in ad hoc projects to help enhance the provider experience with HMSA. These may include but are not limited to enhancements of provider online resources and development of content for the HealthPro news and Provider Resource Center. Analyze relevant data sources to proactively help identify and resolve issues affecting providers. Oversee training activities and the creation of training materials, workflows, and desktop procedures. Prepare and conduct presentations for staff and management. Develop staff in a manner that ensures continual growth and opportunities while maximizing efficiency for providers and the department. Integrate Claims Adjustment Specialists into the Research and Correspondence unit by implementing a plan for the pend resolutions to be worked and ensuring audit compliance. Lead the Research and Correspondence team in technological initiatives including existing application upgrades, adopting new applications, and ongoing refinement of the team's use of the SalesForce application. Coordinate reporting requirements for the unit including but not limited to inventory management reports and ad hoc claim queries. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Monitor the performance and address issues with any business partners or vendors that supports the Members Servicing Department. Build relationships with both internal and external customers to include members and employer groups to address issues and concerns and improve the customer experience. Recruit and retain effective teams through selection, development, compensation and motivation of personnel; develop talents necessary to achieve short- and long-term objectives through effective training, mentoring and coaching. Provides feedback and guidance, including timely completion of interim and annual performance reviews. Monitors overall workflow and prioritizes staff's work. Review financial information and adjust operational budgets to promote and demonstrate desired corporate financial stewardship and outcomes. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Coordinates various projects as assigned. Develops system requirements, test plan, test scenarios, test cases, anticipated test results and objectives and acceptance criteria. Also, performs testing, communicates status/concerns to appropriate parties, documents testing results, develops policies and procedures, and implements policies and procedures into production. Monitors and reviews all new project reports to ensure accuracy. Prepares analysis of financial statements for HMSA and other related entities in an accurate and timely manner. This includes preparation, summarization, and maintenance of any source data in various subsystems of financial data. Assures that all reporting complies with GAAP and CAS standards. Analyzes and interprets these laws/regulations and implements procedures to ensure compliance. Coordinates data that is obtained from other F/A units and other HMSA departments. Performs complex analysis of financial data for both revenue and expenses for HMSA and all of its subsidiary/affiliate companies. Researches the nature and causes of variances and fluctuations in these accounts. Performs analysis independently with limited direction and supervision. Presents findings and recommendations to management. Performs various reconciliation of information from source data to reported amounts. Analyzes and summarizes accounting transactions related to various HMSA contracts/programs to ensure proper recordation into the general ledger for these programs. Communicate effectively with other departments to gather this information. Provides assistance and performs research for various external and internal audits. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the following: Participates in the project planning and analysis process with clients, business analysts and team members. Assist in sizing and the development of timelines. Identifies and refines system requirements. Complies with architecture processes, principles, policies and standards. Assists in buy vs. build recommendations. May provide input into evaluation of system options, risk, cost versus benefits, and impacts on business processes and goals. May evaluate and provide recommendations for application packages. Designs moderately complex solutions. Develops technical specifications for applications. Makes recommendations for the development of new code or reuse of existing code. May identify best sources of data and works with data architects to ensure feasibility with corporate data sources, when needed. Able to extract data from multiple sources. Able to design and implement complex data transformations. Able to load transformed data into information management system. May adjust processes to maximize efficiency of business user queries. Utilizes development platforms, middleware tools and software frameworks for designing and developing solutions when required. Develops or modifies application components using disciplined software development processes. Complies with quality standards and procedures. Participates in software inspections and quality reviews. Uses modern testing practices, builds unit tests and conducts testing to ensure application meets specifications. Implements and executes integration test plans with team. Documents new or modified components, testing activities/results and other areas such as application-wide error handling and backup/recovery procedures. Provides ongoing maintenance of applications. Analyzes existing applications to identify and document opportunities for improvements. Prepares releases for test and production. Validates deployment once released and communicates the change to stakeholders. Provides Tier II (application) support. May provide Tier III level support. Troubleshoots existing systems to identify errors or deficiencies and develops solutions. Delivers solutions as part of a team utilizing agile or waterfall methodology as applicable. Provides feedback for team to improve in feedback sessions and/or retrospectives. Provides technical coaching and mentoring to less experienced team members. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Provides administrative and operational assistance to the various claim department units which include operational support to the adjusters and supervisors, generating supervisory reports, First Notice of Loss, review, index and pay attorney bills, medical and other. Prepares claims data for corporate 1099 reporting, BWH, IRS mis-match review & correction, performing functions necessary to support the claims division on a day to day basis. Operates computer, typewriter and transcribing software and foot pedal to transcribe statements, letters, or other recorded data. Duties: General Support and Training * Serve as a resource to all division personnel and provides training on payment coding when applicable and processing as appropriate. * Relieve receptionist as needed. * Cross-trained to provide coverage in other areas of the Operations Unit. Claims Processing and Coordination * Confirm coverage and enter new WC claims in the claims system, enter claim information into the ISO database via the internet for Casualty, PIP, and WC lines of business and prepare and mail HIPAA forms. * Request policy coverage status from underwriting for new WC claims without a current policy; enter NP claims in log when appropriate. * Coordinate and advise the proper supervisor/adjusters on identified problems/discrepancies. * Create and mail PIP applications, HIPPA forms, and report/enter injury information in the ISO database via the internet. * Investigate, track, prepare letters to vendors, and monitor duplicate payments. Financial Management and Reporting * Produce confidential statistical data in spreadsheet format and compile in specified daily, weekly, and monthly production reports (caseload, diaries, late reserves, delinquent tasks, open claims without a diary, etc.) utilizing systems and other available production and tracking tools. * Produce and balance the daily production and tracking reports vs. the claims income spreadsheet. * Process in accounting software, management-approved 'manual' drafts, record and notify Accounting, ensure that the manual draft is posted by the adjuster in the claims system. * Process computer payments for all units including special vendor levy transactions in the claims system, notifying the responsible unit when there are discrepancies. Also included HPIA claims. * Prepare envelopes, mailing labels, certified mail forms, and return receipts for regular mail or special handling mail. Communication and Correspondence * Compose basic letters to insureds for various situations including explaining deductible credits. * Use a transcribing machine to transcribe recorded statements. * Coordinate transcriptions sent to a vendor. * Research, copy, and notify the appropriate persons of the receipt of a subpoena. Update the applicable records spreadsheet. * Research bankruptcy notices. Update the applicable records spreadsheet. Notify the appropriate adjuster. Data Entry and Systems Management * Import CD data to ImageRight. * Make duplicate copies of CDs as requested. * Possess the knowledge of converting file extensions to other required formats. * Properly document one's actions in the claims system when required as documented in the Claim Assistants' procedures. * Request W9s or W8s when applicable, enter/update the claims system, file documents, and maintain W9 folders. * Ensure that the W9 / W8 is thoroughly completed by the vendor and entered into the claims system to be in compliance with Internal Revenue requirements. * Research DCCA website before calling vendors on oddities. Research, resolve and assist Accounting Department with 1099 discrepancies. Qualifications: * High school diploma or general education degree (GED) required; and 1 year certificate from college or technical school preferred. * Previous insurance experience preferred, but not required * Equivalent combination of education and job-related experience will be considered.

Looking to Supplement Your Income or Just Be Productive? Become an Independent Residential Insurance Inspector with CIS Group! Are you looking for a flexible, rewarding opportunity that allows you to be your own boss and take control of your schedule? CIS Group is seeking motivated, detail-oriented individuals to join our team as 1099 Property Insurance Inspectors. If you own an LLC and are looking to diversify your work, this might be the perfect opportunity for you! Why Work With Us? Since 1996, CIS Group has been one of the largest and most trusted names in the insurance inspection industry. We offer a platform that allows Independent Contractors to create and grow their own businesses, work flexible hours, and take on a variety of inspections. Whether you're supplementing your current work or looking for a new venture, this position offers flexibility and autonomy. What You'll Do: Travel to residential homes to complete exterior (interior photos here and there) property inspections. Take photos, collect property data, and upload your findings using your smartphone or tablet. Provide high-quality, professional service that delivers accuracy and on-time service, with exceptional communication. Maximize this opportunity by utilizing your unique skillset Watch this video to see an example of an exterior-only inspection: Click here to watch What We're Looking For: 1099 Independent Contractors - Be your own boss, set your own schedule! Flexible Hours - Work during daylight hours, Monday through Saturday. Comfortable Working Outdoors - This role requires you to work in various weather conditions. Tech-Savvy - A recent smartphone or tablet capable of taking and storing hundreds of photos. Computer Access - Wi-Fi-enabled for uploading data. Reliable Vehicle & Driver's License - Travel to residential properties within your area. Strong Communication Skills - You're a professional and a persistent communicator. You're not someone who just disappears when things get tough. Microsoft Excel Familiarity - Basic computer skills are necessary for managing your inspections. Compensation: Independent Contractors - You get paid per inspection. Fees - Vary based on location and inspection type, allowing for higher earning potential as you demonstrate competency. Why This Is Perfect for You: You've taught yourself how to solve problems and take on new challenges, and you're driven to succeed no matter the obstacles. This opportunity will allow you to create and or build your own business, and the flexibility to grow your income in an industry that remains resilient even through economic downturns. Ready to take control of your future and join a company that values your persistence and resourcefulness? Submit your resume now and become part of the CIS Group team! Pay = $860 monthly working 1 day per week