Process benefit or refund payments to Providers, Members, and Groups. Submit invoices for approval and process payments based on Federal and State reporting guidelines. Research and resolve payment inaccuracies and effectively communicate with vendors, business associates, and government agencies for payment related issues. Research and respond to benefit payment inquirie

Conducts critical analysis of highly complex and sensitive member and provider inquiries, complaints, grievances and appeals, applies internal policies and procedures, contractual provisions, and regulatory requirements. Secures information from internal and external resources to resolve issues. Functions as a liaison with providers, members and internal decision makers i

Performance Proactively service and grow HMSA products and services through various methods including site visits, on line meetings, telephone and email correspondence, power point presentations, and one on one customer servicing. Protect HMSA's market share through the successful renewal and retention of assigned accounts by strategically aligning HMSA's value propositio

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's

Execute, monitor, and lead implementation of payment integrity strategy. Assess the success of payment integrity activities for continued alignment with organizational goals (e.g., Healthcare Cost Trend) and ensure expected results are being achieved. Communicating external teams' outcomes, data analysis, complex processes and action plans to internal teams. Provides vend

Under the general guidance of the Director Perform risk based, compliance, operational, financial and information technology audits and consulting projects for HMSA. Create and execute audit programs and consulting projects, report findings and recommendations, and perform follow up activities to ensure that management has remediated findings in a timely manner. Establish

Under the general guidance of the Audit Manager Perform audit support functions related to risk based, operational, compliance, financial, and information technology audits, and consulting projects for HMSA. Assist in the execution of audit programs and consulting projects, report findings and recommendations, and perform follow up activities to ensure that management has

Manages community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery, resiliency, and wellness. Advocating in members and families' best interests to ensure needs/choices are accurately represented/supported, and that timely care/services are delivered. Performs screenings/assessments regardi

Coordinate and deliver training programs using an appropriate mode (in person or virtual) to provide understanding of department technology and workflows, relevant laws, and HMSA plans and benefits. Manage logistics of training including planning, scheduling, and preparation of necessary tools and materials. Assist the department with daily business operations and functio

Maintain thorough knowledge of HMSA's provider network and the business with focus on provider contracts and reimbursement methodologies while working collaboratively across departments and our vendor partners to identify, document and maintain business requirements necessary for successful implementation. Researches the current state of HMSA's systems to include QNXT & C

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

General Administrative Support Relieves the CEO/assigned Executive(s) of majority of administrative functions and tasks, ensuring the most effective/efficient use of the Executive's attention and focus. Drafts routine and specialized correspondences on behalf of the CEO/assigned Executive(s). Receives, reviews and determines the appropriate parties to channel/direct sensi

Conduct timely face to face health functional/risk assessments and develop, document, and implement targeted health action plans/care plans based on the results of the assessment for members requiring assistance with care coordination. Coordinate a multi disciplinary team to develop a person centered health action plan/care plan to include but not limited to member's PCP,

Assist the Director to implement Credit Union policies, procedures and practices which include the organization's financial goals, objectives, and budgets. Make business improvement recommendations and coordinate with the Director to seek approval from the Board of Directors. Facilitate, organize, and plan all board meetings, credit union annual dinners and annual busines

Cross Functional Project Team Participation Assist project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Work with stakeholders in the initial project planning stage to help set project objectives and success measures. Provide expertise to project managers for business or data requirements as well as ongoing