Jobs at HMSA

Lead provider reimbursement operations including methodology implementation for institutions, professionals, and ancillaries; manage staff; provide financial analysis and reporting for contracting and network access; participate in negotiations; ensure compliance with contracts and regulatory standards; coordinate fee reviews, audits, budgeting, and cross-functional projects; respond to ad-hoc data requests and represent the organization externally.

Lead cross-functional projects to design, implement, and manage data workflows, reporting, and analytics for health plan reimbursement and payment initiatives. Guide data governance, evaluate systems, automate processes, and mentor analysts to ensure accurate financial and clinical reporting that meets regulatory requirements.

Lead IT category strategy, strategic sourcing, and vendor governance for SaaS, cloud, infrastructure, telecom, and managed services. Drive contract negotiations, cost optimization, cloud consumption and license management, vendor performance oversight, and cross-functional collaboration with IT, legal, finance, and risk to deliver measurable savings and compliance.

Lead product program management for healthcare products and health programs: plan and execute launches, manage vendors and governance, perform product analysis, support go-to-market and implementation, produce executive communications, and optimize program performance and compliance.

Lead category strategy, strategic sourcing, and vendor governance for business services. Manage RFx events, negotiate service contracts, drive cost savings, oversee vendor performance, analyze spend, support budgeting, and partner cross-functionally to ensure compliant contracts and value realization.

Serve as a Provider Operations subject matter expert on projects and process improvements. Independently identify and articulate business needs, perform data analysis to find root causes and recommend solutions, document findings, and resolve complex provider inquiries via written and phone communication. Proactively research issues and support department initiatives.

Prepare, clean, and validate data sources; perform descriptive and predictive analyses using statistical and time-series methods; document reproducible workflows; lead project definition and stakeholder meetings; present findings and train others on MicroStrategy and Excel.

Serve and grow assigned employer accounts by proactively managing renewals, retention, and sales of HMSA products; collaborate with Strategic Account Managers and internal teams; perform business analysis and proposals; educate clients on industry trends; maintain account plans and records; resolve complex service issues.

Coordinate and assign incoming member and provider inquiries, manage staff inquiry volumes to meet SLAs, ensure accurate proofing and record retention, support multiple service channels including in-person, deliver training and QA audits, provide coaching, generate operational reports, and perform related duties.

Provide high-level executive support by managing the executive's calendar, communications, and projects, while coordinating departmental initiatives and administrative tasks.

Lead application support and maintenance, manage production incidents and ServiceNow administration, prioritize and coordinate resources and changes, drive strategic planning and system improvements, lead testing and project delivery, and liaise with stakeholders and vendors.

Designs, develops, and maintains application systems; leads architecture, requirement analysis, and medium-sized projects; provides technical leadership, mentoring, and Tier II/III support; ensures quality, integration, testing, and production readiness across assigned application domains.

Manage and grow assigned employer accounts by servicing renewals, presenting HMSA value propositions, collaborating with SAMs and internal teams, analyzing account utilization, developing proposals, and resolving complex service issues to retain and expand membership and meet sales goals.

Manage and grow a portfolio of employer group accounts by selling HMSA and USAble products. Prospect new groups, retain/renew accounts, develop account strategies, analyze utilization and plan design, present proposals, coordinate cross-functional teams, lead account servicing teams, and maintain activity records and reports.

The Compensation Analyst evaluates job descriptions, administers compensation programs, analyzes salary data, and provides consultative advice on compensation strategies.

The BlueCard Business Analyst II provides production support, conducts data analysis, implements changes, develops training materials, and assists with project implementations.

The Case Resolution Specialist II conducts complex analysis of member and provider appeals, acts as a liaison, and resolves issues by negotiating sensitive matters and implementing changes based on findings.

Responsible for analyzing and resolving complex member and provider appeals and inquiries while ensuring compliance with policies, regulations, and accreditation standards. Works as a liaison to negotiate sensitive issues and identifies areas for improvement in processes. Assists in quality assurance and communicates trends and needs to management.

The Senior Auditor I will conduct audits related to risk management, compliance, and financial practices, reporting findings, and recommending improvements. Responsibilities include interviewing stakeholders, maintaining audit processes, and assisting with administrative tasks.

Conducts risk-based audits and consulting projects. Reports findings, collaborates with management, recommends improvements, and maintains professional knowledge in audit.