69 jobs available
Responsible for leading the support of HMSA's unified communications infrastructure. Responsibilities include, but are not limited to the following: Ensures…
Manage community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery,…
Claims Resolution & Support Serve as the primary liaison for complex escalated claim inquiries from providers, members, account management, and internal…
Financial Performance Management & Business Planning Leads program-level financial performance routines (budget tracking, variance drivers, and corrective…
Conduct open enrollment benefit presentations (second sale), handle current and prospective member inquiries, and support benefit/health fairs at employer…
Research and Data analysis Provide quality, objective, and professional analysis of relevant topics Gather and analyze information to identify trends, issues,…
Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as…
Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures,…
Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application…
Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and operations leadership to develop multi-year category strategies for…
Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as…
Revise and/or develop medical policies adopted from the BCBSA in conjunction with assigned medical director and in accordance with Development and Approval of…
Responsible for providing support to HMSA's network infrastructure. Responsibilities include, but are not limited to the following: Ensures the reliability of…
Performance Meet established marketing plan goals, and achieve annual sales revenue and membership growth objectives by effectively promoting and closing…
Job Description Evaluation: Administers job description process: Reviews job evaluation requests for new or revised job descriptions to determine appropriate…
Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established…
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…
Reporting, Research & Analysis Runs reports assisting analysis of premium revenue, risk adjustment payments, and other revenue streams related to lines of…
Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs Lead and…
Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to:…
Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as…
Legislative Analysis: Develop and analyze significant public policy initiatives. Generate abstracts of legislative issues across the state and country. Define…
Responsible for operating and providing support to HMSA's desktop and end-user infrastructure. Responsibilities include, but are not limited to the following:…
Conducts audits in the operational areas to include: Monthly audits to monitor controls and performance. Document and review findings with operational staff…
Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established…
Enterprise Program Management: Manages multiple high-level, mission-critical, cross-departmental programs and project(s), from design through implementation,…
Reporting, Research & Analysis Analyzes and forecasts premium revenue, risk adjustment payments, and other revenue streams related to lines of business with…
Sales Activities: Meet established marketing plan goals and achieve annual sales revenue and membership growth objectives by effectively promoting and closing…
Manage and lead a membership admin team by providing training, mentorship, and best practice solutions. Manage daily operations of the membership admin team,…
Independently process group and direct payments received from walk-in members and groups while providing all customers with an exceptional customer-focused and…
Prioritizes approved invoices and check requests according to payment terms. Assist with month-end accruals as needed. Familiarizes with company policies and…
Research and Analysis: Research and respond to low to medium complexity internal and external inquires. Is proficient at utilizing a variety of resources…
Performance Pro-actively manage a base of accounts by strategically prioritizing account sales and service activities. Get ahead of the curve on known jeopardy…
Evaluation, interpretation, and processing of clinical review requests to include but not limited to applying the following requirements: Validation that…
Product Strategy & Portfolio Management Own the end to end product strategy for the assigned segment, including benefit design, competitive positioning, rate…
Data Management: Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what…
Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application…
Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in…
Manages community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery,…
Analyzes enterprise-wide financial performance to support strategic planning and decision-making processes Facilitates the development of sophisticated…
Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and business leaders to develop multiyear category strategies for business…
Coordinate and manage deliverables of aspects of utilization management programs by delegated vendors: Ensures that program deliverables, documentation, and…
Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the…
Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established…
Conducts audits in the operational areas to include: Monthly audits to monitor controls and performance. Document and review findings with operational staff…
Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the…
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…
Responsible for operating and providing support to HMSA's network infrastructure. Responsibilities include, but are not limited to the following: Ensures the…
Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting…
Oversee daily cash positioning, concentration, and funding/settlement across HMSA legal entities. Support oversight of corporate banking and financial…
Based on 2 current openings, hmsa jobs earn $1 per hour, with typical pay around $1 per hour.
