Hybrid Program Analyst - Health Plan Ops & Compliance

HMSA; Honolulu (HI); On-site; USD 85,000 - 110,000; Full time

Job summary

HMSA is seeking a professional to monitor, evaluate, educate, and implement FEP program requirements related to UM, CM, MM, and DM activities. You will coordinate cross-functional teams with HMSA staff and external partners to analyze information and drive actions that support FEP plan metrics.

The role includes improving daily customer service and claims processing, documenting policies and workflows, supporting day-to-day operations, and assisting compliance reviews.

Responsibilities

• Monitor, evaluate, educate, and implement FEP program requirements related to UM, CM, MM, and DM activities.
• Coordinate cross-functional teams to collect, analyze information and make recommendations to support FEP Plan Incentive Program (PIP) metrics and 2020 strategic goals.
• Develop methods to improve daily customer service and claims processing operations and document policies, procedures, and workflows.
• Support day-to-day business operations by compiling and reporting on daily activities and identifying trends.
• Support compliance reviews and audits to ensure adherence to federal/state regulations; implement best practices and resolve findings.
• Identify and protect FEP assets through FWA methodologies and coordinate resolution of trends.
• Perform miscellaneous responsibilities as assigned or directed.
• Travel to Association-sponsored trainings and meetings to stay current with FEP landscape and regulatory changes.

Job description

HMSA is seeking a professional to monitor, evaluate, educate, and implement FEP program requirements related to UM, CM, MM, and DM activities. You will coordinate cross-functional teams with HMSA staff and external partners to analyze information and drive actions that support FEP plan metrics.

The role includes improving daily customer service and claims processing, documenting policies and workflows, supporting day-to-day operations, and assisting compliance reviews.