Manager, Membership Admin

HMSA • Honolulu, HI

16h • Hybrid

About The Position

1. Manage and lead a membership admin team by providing training, mentorship,
and best practice solutions.
2. Manage daily operations of the membership admin team, including inventory
analysis, tracking and resolution
3. Serve as the escalation point for complex or disputed cases and drive
resolution within defined SLA.
4. Monitor and analyze key performance indicators (KPIs) and take corrective
actions to improve efficiency, accuracy, and customer satisfaction
5. Collaborate with key stakeholders to include underwriting, LOB, legal,
servicing teams to ensure a consistent and integrated approach to accurate
and timely case processing.
6. Maintain documentation, audit trails, and reporting in line with internal
controls and external compliance requirements.
7. Contribute to the development and implementation of new policies,
procedures, and systems to improve membership admin operations.
8. Stay current with changes in laws, regulations, and industry best practices
related to membership admin management. Performs all other miscellaneous
responsibilities and duties as assigned or directed.

Requirements

• Bachelor's degree and five years of related work experience; or equivalent combination of education and related work 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 working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

Responsibilities

• Manage and lead a membership admin team by providing training, mentorship, and best practice solutions.
• Manage daily operations of the membership admin team, including inventory analysis, tracking and resolution
• Serve as the escalation point for complex or disputed cases and drive resolution within defined SLA.
• Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction
• Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely case processing.
• Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
• Contribute to the development and implementation of new policies, procedures, and systems to improve membership admin operations.
• Stay current with changes in laws, regulations, and industry best practices related to membership admin management.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager