Program Analyst, Federal Employee Program

HMSA•Honolulu, HI

5d•Hybrid

About The Position

This role involves monitoring, evaluating, educating, and implementing Federal Employee Program (FEP) requirements related to Utilization Management, Case Management, Medical Management, and Disease Management. The analyst will coordinate cross-functional teams, develop methods to improve customer service and claims processing, support business operations, and ensure compliance with federal and state regulations. A key aspect of the role is identifying and protecting FEP assets by analyzing and evaluating Fraud, Waste, and Abuse (FWA) methodologies. The position also requires travel to various training programs, meetings, and conferences to stay informed about the FEP landscape and industry developments.

Requirements

Bachelor's degree and three years of related work experience; or equivalent combination of education and related work experience.
Basic working knowledge of Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
Must have a valid driver's license.
Must have access to an automobile with current license, registration, and no-fault insurance.
Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business-related activities.

Responsibilities

Monitor, evaluate, educate, and implement FEP program requirements related to Utilization Management (UM), Case Management (CM), Medical Management (MM), and Disease Management (DM) activities.
Track daily operations to ensure deliverables are met and report information to the FEP Director's Office, various internal committees, and other audiences.
Coordinate cross-functional teams to collect, communicate, and distribute information and conduct quantitative/qualitative analysis to identify areas of opportunity and make recommendations for department/corporate action.
Develop methods to improve daily customer service and claims processing operations and practice standards.
Analyze business problems, identify enhancements for functionality, and redesign systems to improve efficiencies.
Document policies and procedures, desktop procedures, and workflows.
Support day-to-day business operations and functions by compiling and reporting on daily activities.
Identify trends in operational efficiencies, research inquiry escalations, respond to secured messages, and perform administrative tasks.
Support compliance reviews and audits to monitor adherence with federal and state regulations, FEPDO program rules, Office of Personnel Management (OPM) regulatory guidance, and internal policies and procedures.
Ensure that "best practices" are implemented and observations/findings are satisfactorily resolved.
Identify and protect FEP assets through detailed analysis, review, and evaluation of Fraud, Waste, and Abuse (FWA) methodology and best practices.
Take a proactive role in identifying, digesting, and communicating trends and assist in coordinating resolution for these trends.
Perform all other miscellaneous responsibilities and duties as assigned or directed.
Travel to Association-sponsored Plan training programs, meetings, and conferences to understand the current FEP landscape, industry developments, policy or regulatory changes, transformative technologies, operational processes, field service strategies, and other implementing an overall effective FEP program.