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

Employee Relations Activities Maintains an understanding of the legal and business risks involved in all employee relations issues, including investigations, inquiries, and complaints. Records and produces notes based on this understanding, considering all applicable employment laws, regulations, and guidelines to ensure compliance and prevent liability. Creates, organize

Engagement, Assessment, and Planning Conduct comprehensive assessment including a health and functional assessments (HFA) or initial assessment (IA) by gathering clinical information which includes past medical history, medications, physical/psychosocial factors, cultural influences, evaluation of health care barriers to include available support systems, available benefi

Support the development of new products and benefits by performing the analysis and coordinating the efforts of others to produce the necessary information to be used in decision making by HMSA leadership. Produce comprehensive assessments of proposed changes through collaborative efforts with internal partners and subject matter experts. Prepare financial, brand, regulat

Engagement, Assessment and Planning Engages members in the case management program (outreach and successful enrollment) using diagnostic cost group classifications or other tools which identify the relative risk score and illness burden. Identifying catastrophic health care users with significant health care costs is a priority. Conducts and documents a comprehensive asse

Lead the oversight and monitoring of the medical cost trend improvement efforts, by driving cross functional teamwork efforts to identify, design, implement, and monitor initiatives that moderate the Organization's healthcare cost trends Lead and manage a portfolio of activities with a sharp focus on enhancing healthcare cost outcomes through diversified mitigation strate

Responsibilities include, but are not limited to the following Leads and manages the Identity Access Management team. Acts as a point of escalation for any user or business stakeholder issues. Establishes and maintains relationships with business units throughout the organization so as to understand their working environments and communications needs. Recommends and overs

Responsibilities include, but are not limited to the following Influence information strategy By partnering with business unit leadership, and through the rationalization of the information value chain, the information architect will provide strategic recommendations to maximize the value of information assets via their creation, access and use. Promotes the business valu

Prepare administrative work for the Health Coordinators to include but not limited to preparing HFA's, inputting 1147's, completing the call cadence to enroll members in the program, utilizing HMSA tools to identifying any gaps in care. Ensuring that services are initiated timely to include but not limited to assisting the Health Coordinator in monitoring service plan goa

Monitor, track and analyze legislation introduced at the state level. Generate weekly Executive Summary Report of key legislation. Develop and distribute weekly updates to HMSA executive staff throughout the legislative session. Monitor legislative hearings and meetings as needed. Conduct legislative research and compile summary reports on state and national health care i

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

Quality Improvement Interventions Analysis and Development Work as part of a quality team to continuously identify, plan, develop, implement, and evaluate interventions. Develop reports, analyses, and data mining to support program planning and interventions. Complete program and initiative evaluations such as return on investment and health outcomes Apply detailed analys

Quality Improvement Interventions Analysis and Development Work as part of a quality team to continuously identify, plan, develop, implement, and evaluate interventions. Complete program and initiative evaluations such as return on investment and health outcomes Gather and synthesize research studies, industry information, and BCBSA resources to gain insight and apply bes

Design Solutions Serve as a technical leader on our most demanding, cross functional projects. Balance technical leadership with strong business judgment to make the right decisions about technology choices. Decompose complex problems into simple, straight forward solutions, while fully understanding system inter dependencies and limitations. Evaluate system options, risk

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.