Establishes relationships with business partners and the IT organization in order to provide technical solutions to meet user needs and influence strategic initiatives. Responsible for leading the analysis of IT requirements, alignment of IT resources and processes in order to meet the clients' organizational needs, as well as the design of enterprise solutions. Responsib

Develop and maintain processes and reports for internal and external performance monitoring of all provider database and credentialing activities to ensure compliance with corporate performance and/or regulatory guidelines. Understanding of healthcare laws and regulations, program guidelines and HMSA contractual obligations that affect Provider Operations' business areas.

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.

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

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

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

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

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

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

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