Manage 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. Coordinate and collaborate with licensed

Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and highly complex issues that include medical or payment policy questions and provider appeals. Resolve root problems to ensure compliance with contract terms and servicing goals. Communicates directly with providers and office staff

Perform FWA incident oversight and SIU staff development activities Provide direct oversight to other SIU staff by reviewing and providing feedback to Investigators for written correspondences and regulatory referrals. Provide day to day advice/guidance to SIU staff on FWA incidents including decisions to open and/or close SIU incidents. Create, update and present trainin

SIU case investigation management, resolution and prevention Manage complex FWA case investigations, collaborate with federal, state and law enforcement entities, and provide applicable notifications as required. Conduct pro active FWA case investigations and resolutions. Maintain extensive documentation and evidence for SIU cases. Recommend and implement preventive measu

Job Description Evaluation Administers job description process Reviews job evaluation requests for new or revised job descriptions to determine appropriate job leveling and FLSA exemption status. Utilizes job evaluation criteria and available salary market data. Reviews job description content, evaluation questionnaires and job equity guidelines to ensure evaluation metho

Provides general production support Monitor daily production performance and inventory levels as assigned. Conduct data and trend analysis to identify areas of improvements. Triage daily production issues. Recommend and implement interim workarounds. Recommend solutions and/or corrective actions for issues that are brought to the attention of the unit. Create and update o

Independently research and design original materials from beginning concept to final product. Interpret/understand project requirements from job request form and/or meetings with Communications Program Manager and/or customer. Lead design concept sessions with design team, comm staff and business partners as needed. Design and create materials according to project specs a

Sales Activities Meet established marketing plan goals and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities. Must generate robust sales activities including self generated marketing and email campaigns, outbound calls to assigned existing lead lists. Perform quick and efficient transaction f

Research and Analysis Serve as contact for external vendors and internal departments to support operations and payment integrity activities. Research and respond to low to high priority complex internal and external inquiries. Analyze and coordinate vendor performance reviews using KPIs (e.g., recovery yield, turnaround time, false positive rates, provider abrasion). Coor

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 relationships with HMSA's customers/members and other consumers by becomin

a. Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by Researching and collaborating with other units or departments to find a solution Accurately updating member records Contacting external partners who provide services for/to HMSA

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 incl

Mentor servicing representatives to ensure the best customer experience by supporting representatives after they complete classroom training; completing quality assurance audits that ensure timeliness, accuracy, professionalism, and an optimal customer experience; and providing timely, relevant coaching in professional and constructive manner. Be available at all times fo

a. Research and Data analysis Provides quality, objective, and professional analysis of relevant topics. Gathers and analyzes information to identify trends, issues, innovations, and solutions for priority business needs. Develops design analysis frameworks Prepares reports Presents results with recommendations Implements solutions Identifies, analyzes, interprets, and su

Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and medium complex issues that include medical, or payment policy questions and provider appeals. Resolve root problems to ensure compliance with contract terms and servicing goals. Communicates directly with providers and office staff