HMSA jobs in Urban Honolulu, HI

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 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. 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. 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. Analytics/Reporting Tool Development & Training: Participates in the development and delivery of analytics/reporting tools for internal and external customers. Types of projects include the development and or maintenance 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. 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

Research and Data analysis Provide quality, objective, and professional analysis of relevant topics Gather and analyze information to identify trends, issues, innovations, and potential problems and solutions related to internal operations performance Develops analysis Present results with recommendations Supports execution of solutions Develop performance optimization strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values. Helps to lead and contributes to strategic design and implementation of performance improvement initiatives. Works with key stakeholders to strategically design and implement health strategy initiatives with guidance from executive sponsors, subject matter experts, and other staff as needed Serving as a lead subject matter expert, determines and develops business requirements Cross-Functional Integration and Communication:* Work directly with cross-departmental team members to complete tasks, facilitate communication, and provide status updates Work with the project team, HMSA departments and external partners to monitor, collect, communicate, and distribute information. Appropriately identify communication needs and timelines; Communicate analysis, assessments, recommendations and completed work product through professional written and oral reports and presentations. Responsible for representing the Command Center department to internal and external partners when appropriate. Other duties On a regular, sustained basis, cooperates with other staff members both within and outside the department in the accomplishment of one's own job duties as well as assisting other in accomplishing theirs. Special Projects Managements Assist with vendor management and evaluation. Perform all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Manage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely claims processing. Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements. Contribute to the development and implementation of new policies, procedures, and systems to improve claims operations. #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

Responsible for leading the support of HMSA's unified communications infrastructure. Responsibilities include, but are not limited to the following: Ensures the reliability of HMSA's unified communications infrastructure, to include the planning and implementation of enhancements. Implements, maintains and upgrades HMSA's unified communications infrastructure. Updates configuration management tools. Documents procedures and configurations. Administers the unified communications environment, to include the setup, deployment, and maintenance of component systems. Liaises with business units to develop and maintain an understanding of call center operations and requirements. Coordinates with business units to test and implement enhancements to unified communications components such as call center infrastructure. Provides technical expertise across business functions, and understands the relationship between the business and the Information Systems Department. Explains infrastructure capabilities. Consults with other Information Systems Department teams regarding infrastructure requirements and provides recommendations for both the design and implementation of systems integration activities. Reviews and makes recommendations with respect to IT infrastructure that deviates from established architecture standards. Leads project planning and requirements gathering efforts. Recommends and creates action plans for systems development and / or integration. Identifies the need for major support contracts. Reviews vendor proposals. Prioritizes, plans and implements upgrades and ensure that change management procedures are implemented and followed. Prioritizes, plans and implements infrastructure repairs and installations. Coordinates and plans activities with vendors. Ensures that asset and Oversees the conduct of disposal procedures are adhered to. Designs and implements infrastructure replacement plans. Maintains inventories as appropriate. Monitors Key Performance Indicators and maintains service levels to ensure that requirements are met or exceeded. Escalates problems as required. Informs management as appropriate. Troubleshoots and diagnoses complex and escalated problems. Works with multiple vendors to coordinate the resolution of issues. Reviews logs and maintains Information Technology Service Management tools to document changes and identify recurring problems. Identifies the training needs of users. Shares knowledge with users and other Information Systems Department staff. Updates users on the status of incidents and problems. Ensures that follow-up procedures are adhered to. Tracks customer satisfaction. Participates in long-term infrastructure strategy and planning. Participates in rotating on-call support schedules. Provides after-hours support to business operations, as needed. Supports remote locations across the Hawaiian Islands, to include overnight travel, as needed. Mentors and assists in the professional development of less experienced staff. Required to be on-call for critical incidents as they arise. Employee must participate in continuing education and training as needed or assigned. This is to ensure an accurate and updated knowledge base. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

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

Prioritizes approved invoices and check requests according to payment terms. Assist with month-end accruals as needed. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensure that the cost center and the amount being charged are authorized. Validates vendor id to ensure that the appropriate vendor and payment method are populated on the smart connect template for upload and posting. Verifies completed smart connect data against approved invoicesand check requests for accuracy. Audits work of peers, provides guidance and assists with crosstraining of tasks with peers Processes more complex, exception situations involving vendor invoices, check requests and employee expense reports. Reconciles more complex vendor accounts and resolves vendor issues timely. Recognizes potential problem situations and escalates to management as needed. Assists with testing of new function. Transforms certain processes/procedures to improve efficiency Researches inquiries including more complex and sensitive inquiries for management, other departments and vendors. Provides Accounts Payable related special projects support to management. Balances Dynamics A/P system reports and be able to reconcile all special and A/P balance sheet accounts. Creates and updates vendors according to the approved invoices, check requests, supporting documents and complies with the IRS requirements. Assists with TIN matching, verbal confirmation of ach instructions and recording of journal entries timely and accurately. Assists with check printing, check log, email remittance and upload to Documentum. Performs all other miscellaneous responsibilities and duties as assigned or directed #LI-Hybrid

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

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

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

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

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.

Stakeholder Support: Support product managers by eliciting stakeholder input, documenting product needs, and participating in discussions across the product lifecycle. Assist with stakeholder communications to clarify goals, document decisions, and follow up on action items. Learn to understand the vision, goals, and operational needs of business units. Solution Design: Assist in eliciting and translating business requirements into user stories, acceptance criteria, test cases and solution documentation. Coordinate across agile team members to ensure requirements are understood and tracked. Support efforts to validate that delivered solutions meet business needs. Collaboration and Coordination: Participate in agile ceremonies (daily stand-ups, sprint planning, retrospectives, etc.). Collaborate closely with product owners, developers, testers, and designers. Document decisions, coordinate follow-ups, and track work items using team tools. Drive and coordinate initiatives from intake, analysis, design, build, test, deployment and support by managing product scope, user stories, sprint dates, issues, risk and communications. Product Roadmap: Assist with the maintenance of product roadmaps and backlogs. Help prioritize user stories based on input from senior product managers and business stakeholders. Coordinate reviews and demos with stakeholders to align expectations. Enterprise Agile Support: Learn HMSA's agile and product management frameworks. Support process improvement initiatives by contributing feedback and identifying gaps in tools or workflows. Vendor Evaluation: Support the evaluation of third-party tools by compiling requirements and documentation. Assist with vendor communication tracking and documentation. Performance Outcomes: Support product managers in tracking key performance indicators (KPIs), preparing reports, and documenting results. #LI-Hybrid

* Collect, analyze, and utilize data and feedback related to the Provider Call Center to provide audit oversight upon predefined contractual criteria and identify opportunities to improve operations between HMSA and the vendor team. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO). Compile reports about incidents, events, and updates regarding provider HHIN and phone inquiry issues and provide database management for any escalations. * Gathers, reviews, and analyzes information to identify trends, issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing. This includes reviewing and validating new implementations. * Initiates the development of strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values. Provides critical assessments of information and data about current trends and issues and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific HMSA actions, including business process improvements. * Conducts ongoing research and analysis to assess changing needs of our industry. Provides quality, objective, and professional analysis. Initiate change and evaluate impact. * Communicate with vendor team and internal stakeholders to quickly and accurately obtain or provide information regarding HHIN inquiry and provider call updates. * Works directly with cross-departmental team members to complete tasks and provide status updates. Works with the project team, HMSA departments and external partners to monitor, collect, communicate, and distribute information. * Communicates analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations. Conducts presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) and our vendor partner to ensure reporting of quality outcomes are consistent and understood. * Provides guidance and assistance to the vendor team to ensure training programs are up-to-date and effective. * Communicate process changes to vendor to stay current with government and commercial health plans, agencies and other entities' guidelines. * Engages and collaborates with project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Supplies or advises in the development of requirements, reports, budgets, and other analyses, and help solve operational issues and roadblocks. * Organize, maintain, and keep readily accessible, all references, documents, policies, and procedures to ensure accuracy on the part of the vendor. * Read, analyze, and interpret business documents such as HMSA's Medical Policy Manual, plan certificates and Guide to Benefits, statistical data, product development memos and documents published by Blue Cross and Blue Shield Association related to program compliance; the Federal and/or state governments pertinent to the business (i.e. Federal Register, CMS guidelines, Hawaii Revised Statutes (H.R.S). Work collaboratively with the Customer Relations Content Administrator to ensure online resources are up to date. * Ensures all appropriate processes are followed and documentation is completed as required by acting as quality control checkpoint verifying standards are adhered to. * Proactively resolve issues that could impact providers and members and providers. * Maintain knowledge of current health plan and agency requirements. * Performs all other miscellaneous responsibilities and duties as assigned or directed. * Bachelor's degree and two years of related work experience; or equivalent combination of education and work experience. * Effective verbal and written communication skills * Strong project and process management skills * Basic knowledge of Microsoft Office applications including Word, PowerPoint, Excel, and Outlook.

Data Analysis and Reporting Conduct high quality, objective analysis to support performance optimization and strategic initiatives. Collect, interpret, and evaluate Key Performance Indicators (KPIs) and related information to identify trends, issues, root causes, and potential problems while proactively recommending solutions that support performance optimization including process improvement. Design and build reports, dashboards and visualizations that effectively communicate insights to stakeholders. Present findings with clear, actionable recommendations to drive performance improvement. Collaborate with cross-functional teams to support the execution and monitoring of recommended solutions. Support ongoing operational and ad hoc reporting needs, by extracting and analyzing data to support government compliance, business reporting needs, and operational decision-making, etc. Helps to lead and contributes to strategic design, implementation, and management of roadmaps, strategic frameworks, and other continuous improvement initiatives within operations. Partners with key stakeholders to identify opportunities, co-design solutions and implement continuous improvement initiatives with guidance from executive sponsors, subject matter experts, and cross-functional teams. Collaborates with the IT and Corporate Analytics teams to define and develop business requirements for report optimization and enhancements. Cross-Functional Integration and Communication: Work directly with cross-departmental team members to complete tasks, facilitate communication, and provide status updates. Work with the project team, HMSA departments and external. partners to monitor, collect, communicate, and distribute information Appropriately identify communication needs and timelines; Communicate analysis, assessments, recommendations and completed work product through professional written and oral reports and presentations. Represent the Command Center department to internal and external partners when appropriate. Other duties. On a regular, sustained basis, cooperates with other staff members both within and outside the department in the accomplishment of one's own job duties as well as assisting other in accomplishing theirs. Assist with vendor management and evaluation. Perform 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 * Bachelor's degree or its equivalent in Information Technology, Computer Science, or related computer or engineering field and three years of systems analysis and programming experience. May substitute a higher level of degree in Information Technology, Computer Science or related computer or engineer field and less work experience or equivalent combination of education and related work experience. * Requires increased skill in multiple technologies and detailed knowledge of one segment of the business. * Requires advanced programming techniques and application design. May require knowledge of distributed systems architecture, middleware or object oriented analysis and design.

* 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 * Bachelor's degree and five years of related work experience; or an equivalent combination of education and related work experience. * One year of experience in a management/supervisory/leadership role. * Excellent verbal and written communication skills * Excellent customer service skills * Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.