HMSA-posted 3 months ago
Honolulu, HI
1,001-5,000 employees

The position involves providing strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies. The role ensures alignment with business requirements, state and federal regulations, and accreditation standards. The individual will develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance. Collaboration with external partners, IT, Claims Operations, Provider Services, Compliance, and Product teams is essential to ensure system configurations support new products, regulatory changes, and organizational initiatives. The position also requires leading testing, validation, and sign-off processes for new configurations, system upgrades, and change requests. Additionally, the role involves driving process improvements and automation opportunities to enhance configuration efficiency and reduce errors. The individual will serve as a subject matter expert (SME) for configuration management, providing training, guidance, and mentorship to internal and external team members and business stakeholders. Miscellaneous responsibilities and duties may also be assigned or directed.

  • Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies.
  • Develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance.
  • Collaborate with external partners, IT, Claims Operations, Provider Services, Compliance, and Product teams.
  • Lead testing, validation, and sign-off processes for new configurations, system upgrades, and change requests.
  • Drive process improvements and automation opportunities to enhance configuration efficiency and reduce errors.
  • Serve as a subject matter expert (SME) for configuration management.
  • Provide training, guidance, and mentorship to internal and external team members and business stakeholders.
  • Perform all other miscellaneous responsibilities and duties as assigned or directed.
  • Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
  • Five years of management/supervisory experience.
  • In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans.
  • Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge).
  • Effective written and verbal communication skills.
  • Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.
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