- Collects, analyzes, and utilize data and feedback to identify opportunities to improve the relationship between the business and the other entity. 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 claims, enrollment, and/or other intake and print & fulfillment area issues and conflicts.
- 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 functionality and/or redesigns of systems to improve efficiency, financial models of costing and pricing. Reviews and validates new implementations
- Participates in and conducts root cause analysis/discussions.
- Initiates in the development of strategies based on resources, constraints, and HMSA values. Provides critical assessments of data about current trends and issues and actively shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific actions, including business process improvements.
- Initiates change and evaluates impacts.
- Conducts ongoing industry research and analysis to assess changing needs.
- Communicates with vendor and internal stakeholders to obtain or provide information regarding claims processing, enrollment, and/or other intake and print & fulfillment related updates:
- Collaborates 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 reports and presentations. Presents to all levels of the organization (unit meetings, department meetings, management meetings, etc.) and our vendor partner.
- Understands technical aspects of Print & Fulfillment (i.e. IP address configuration, file formats, etc.) to resolve issues
- Ability to troubleshoot production problems related to ID cards and enrollment materials, as well as check and Explanation of Benefit (EOB) generation.
- Perform customization of the EOB's, ID cards, and payments.
- 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 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 contractual obligations are met/upheld between HMSA & its customers.
- * Read, analyze and interpret business documents such as HMSA's Medical Policy Manual, plan certificates and Guide to Benefits, mapping documents, product development 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), HIPAA compliance and security policies.
- Ensures all appropriate processes are followed and documentation is completed as required by acting as quality control checkpoint.
- Understands how the vendor issues provider (Automated Clearing House) ACH/835 enrollment, print production, and ACH payment delivery.
- Collaborates with others to create new solutions as changes occur.
- Proactively solves conflicts and addresses issues that could occur between HMSA, customers, service providers, and vendors.
- Maintain knowledge of current health plan and agency requirements
- Perform all other miscellaneous responsibilities and duties as assigned or directed.
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HMSA
May 16, 2025