hmsacareers

Fill customer requests for services across a variety of operational support functions, including: Audio/visual equipment loans, setup, and support. Confidential document recycling and secure disposal services. Facilities management support and coordination. Internal pickup and delivery services. Inv

Manage CFR Team You are responsible for leading and managing the contracting function in Provider Services and overseeing the work of the employees in the CFR department as well as outside contracted vendors. These responsibilities include, but are not limited to, the following: Leadership. Provide

Financial Performance Management & Business Planning Leads program-level financial performance routines (budget tracking, variance drivers, and corrective action plans). Develops business cases and financial impact assessments for Medicaid initiatives. Supports forecast inputs through structured mon

Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to: Institutions, Professionals, and ancillary providers. Provide management reports and analysis needed for decision making, physician and institutional

Research and Analysis: Research and respond to low complexity internal and external inquires. Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical consultants, other Blue Cross/Blue Sh

Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application system(s). May participate in development, maintenance and support activities. Leads or participates in the project planning process with clien

Stakeholder Engagement Builds and sustains strong relationships with executive leaders, business partners, and external stakeholders to advance strategic priorities and enterprise alignment. Evaluates complex business challenges and guides the development of innovative, scalable solutions that suppo

Performance Meet established marketing plan goals, and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities. Perform quick and efficient transaction fulfillment of telephone calls or email from prospective or current HMSA

Encounter Submissions Management Communicates with LOB leads and Governance Finance Director on the necessary information and context for strategic business decision making. Establishes schedule for meetings and deliverables to complete needs of all 3 lines of business encounter submissions. Support

Enterprise Program Management: Manages multiple high-level, mission-critical, cross-departmental programs and project(s), from design through implementation, with guidance from executive sponsors and/or business owners: Facilitates the definition of project scope, goals, and deliverables. Develops f

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 promo

Research and Analysis: Research and respond to low to medium complexity internal and external inquires. Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines, plan certificates, provider contracts. Make

Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the following: Leads and/or participates in the project planning process with clients, business analysts and team members. Assists in the developm

Manage and lead a membership admin team by providing training, mentorship, and best practice solutions. Manage daily operations of the membership admin team, including inventory analysis, tracking and resolution Serve as the escalation point for complex or disputed cases and drive resolution within

Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application system(s). May participate in development, maintenance and support activities. Manages, leads, and/or participates in the project planning proc

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 th

Legislative Analysis: Develop and analyze significant public policy initiatives. Generate abstracts of legislative issues across the state and country. Define business needs to develop recommendations for HMSA's external policy positions. Manage processes across internal departments to develop recom

CUSTOMER EXPERIENCE Provide 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. Build enduring

Claims Resolution & Support Serve as the primary liaison for complex escalated claim inquiries from providers, members, account management, and internal departments. Research and resolve complex claim discrepancies, denials, adjustments, and payment issues within established service-level agreements

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 recommend