Tracks, monitors, and forecasts the non claims benefit expense spending and projections. Under the direction of the manager or lead, Meets with various department heads and business owners to gain insights on future contracts and initiatives. Understands the objectives/goals of these initiatives that are often strategic and complex in scope. Collaborates with leaders in a

Creative Independently research and design original materials from beginning concept to final product. Interpret/understand project requirements from job request form and/or meetings with Executives, Communications Program Manager and/or customer. Design and create materials according to project specs and through research/inspiration. Lead conceptual meetings with design

Direct and oversee all aspects of claims operations, in alignment with corporate goals and initiatives. Ensure and communicate overall claims performance meets/exceeds Key Performance Indicators by evaluating, analyzing and interpreting data and metrics. Ensure cross functional collaboration and partnerships are developed and maintained in support of functional alignment.

Leave of Absence (LOA) and Accommodation Case Management Manages all aspects of leave and accommodation cases by providing extensive case management, coordinating administrative aspects of the case and any applicable claims. Interprets and proactively administers leave and accommodation programs and policies in accordance with the applicable federal and state employment l

Leadership and Performance Management Develops short term and long term strategies to meet risk adjustment accuracy goals and requirements. Works internally, and with BCBSA, providers, and vendors to review programs, processes, and data collection for improvement opportunities. Manages the production of performance dashboards to monitor and report ongoing performance agai

Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established standards that support HMSA's ability to comply with customer performance requirements, while receiving and responding to inquiries. Conduct research for routine inquiries. Apply basic analytical and problem solving sk

Evaluation, interpretation, and processing of clinical review requests to include but not limited to applying the following requirements Validation that requests has met submission requirements based on accreditation / governmental regulation requirements. Educate and/or communicate with provider offices on appropriate procedures. Application of internal policies and proc

Creates original content that engages our target audience and supports HMSA's business goals and objectives Researches, produces, writes, shoots, and edits in house videos and livestreams. Writes clear and compelling stories in HMSA's brand voice. Writes effective digital headlines and summaries that help attract audiences. Creates engaging social media posts that attract

Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established standards that support HMSA's ability to comply with customer performance requirements, while receiving and responding to inquiries. Conduct research for routine inquiries. Apply basic analytical and problem solving sk

Maintaining Application Systems Prioritizes and coordinates application support efforts. Updates management on escalated issues on a regular basis. Supports and maintains Production incidents tracking on a daily basis by managing and responding to Production incidents based on their severity level. Ensures resources are allocated to cover after hour problems. The Applicat

Coordinate and manage deliverables Collaborate with subject matter experts to identify and implement process improvement Perform and/or coordinate planning, research, and analysis to ensure deliverables, documentation, and reporting are complete and meet contractual, compliance, and accreditation requirements Analyze busines issues and provide recommendations to managemen

Facilitates complex projects and functions of high importance as an independent project lead. Plans and manages the project development process and oversees implementation. Analyzes intricate project objectives, data sources, methodology, data summaries and findings, and prepares and edits draft, revised and final reports for dissemination to key project sponsors to meet

Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program/plan cost and utilization. Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities. Monitor market t

Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs Lead and implement internal controls; facilitate definition of data and other information requirements; define efficient data assembly methods; and maintain adequate documentation for general reference and audit purposes. Interp

Promote leadership, engagement, accountability, and innovation by mentoring staff and managing all personnel related tasks fairly and consistently, including but not limited to auditing employee performance, administering training, developing and monitoring personalized Performance Management Programs, implementing employee improvement plans, addressing workplace personne