Health Plan Program Analyst: Operations & Compliance

Socket.dev; Honolulu (HI); On-site; USD 65,000 - 90,000; Full time

Job summary

Socket.dev seeks a FEP program analyst to monitor, evaluate, educate, and implement FEP program requirements across Utilization Management, Case Management, Medical Management, and Disease Management within the department. This role tracks daily operations and reports to the FEP Director's Office and other audiences as needed.

Responsibilities include coordinating cross-functional teams, analyzing metrics for PIP goals, improving customer service and claims processing, supporting compliance

Qualifications

• Bachelor's degree with three years of related work experience or equivalent.
• Proficient with Microsoft Office applications (Word, Excel, PowerPoint, Outlook).
• Must have valid driver's license and access to insured vehicle for off-site travel.
• Willingness to travel for training, meetings and conferences.

Responsibilities

• Monitor, evaluate, educate, and implement FEP program requirements across UM, CM, MM, and DM activities.
• Coordinate cross-functional teams to collect, communicate and analyze information for PIP metrics and strategic goals.
• Develop methods to improve daily customer service and claims processing operations and document workflows.
• Support day-to-day operations by reporting on activities and identifying trends.
• Assist in compliance reviews and audits to ensure adherence to regulations and internal policies.
• Identify and protect FEP assets through FWA analysis and trend communication.
• Travel to plan trainings, meetings and conferences to stay abreast of FEP landscape and implement changes.
• Perform other duties as assigned.

Education

Bachelor's degree + 3 years related work experience or equivalent

Tools

Microsoft Office (Word, Excel, PowerPoint, Outlook)

Job description

Socket.dev seeks a FEP program analyst to monitor, evaluate, educate, and implement FEP program requirements across Utilization Management, Case Management, Medical Management, and Disease Management within the department. This role tracks daily operations and reports to the FEP Director's Office and other audiences as needed.

Responsibilities include coordinating cross-functional teams, analyzing metrics for PIP goals, improving customer service and claims processing, supporting compliance