The Role
Manage Inter-Plan (BlueCard) program governance and policy interpretation, research and resolve complex claims using ITS/Blue2 and reference databases, coordinate communications and payments, produce and compile reporting, lead process improvements and training, liaise with multidisciplinary teams and vendors, and support national BCBS projects and initiatives.
Summary Generated by Built In
Job Summary & Responsibilities
- Provides and interprets all program guidance internally regarding Inter-Plan Program policies and manuals being accountable for all Inter-Plan governance and policy matters. Monitor and effectively manage inventory of unresolved complex inquiries to provide timely follow-up and accurate resolution of BlueCard claims for HMSA customers.
- Use ITS, Blue2 systems, reference databases, applications, and other tools to research claims questions and inquiries
- Coordinate communication and decisions related to Inter-Plan Programs and other Inter-Plan functions. Lead and distribute BCBSA communications to appropriate individuals within the Plan working with various internal departments. This includes coordinating payment for claims due to dual or more membership.
- Lead and participate to reporting team in reporting requests to produce data and ensure BlueCard clams are being processed and paid accurately. Compile reports about incidents, events, and updates regarding claims processing issues and conflicts. This includes providing recommendations and resolutions.
- Coordinate with multidisciplinary teams; present and influence senior decision makers to secure necessary resources and funding to support National and BCBS Association projects.
- Apply advanced knowledge and service as unit's SME. Participate and lead meetings on workflow changes, identifying training needs, process improvements, and project implementations including our vendor and internal areas
- Complete or participate in corporate training, compliance certification or initiatives as directed by upper management
Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Bachelor's degree and four years of related work experience; or an equivalent combination of education and work experience
- Excellent verbal and written communication skills
- Project and process management skills, with the ability to handle multiple vendors and multiple contracts
- Intermediate level knowledge of Microsoft Office applications. Including but not limited to Word, Outlook, Excel, and Power Point.
Skills Required
- Experience using ITS and Blue2 systems to research and resolve claims
- Subject matter expertise in Inter-Plan Program policies (BlueCard)
- Ability to coordinate with multidisciplinary teams and influence senior decision makers
- Bachelor's degree or equivalent combination of education and experience
- Four years of related work experience (or equivalent)
- Excellent verbal and written communication skills
- Project and process management skills, ability to manage multiple vendors and contracts
- Intermediate knowledge of Microsoft Office (Word, Outlook, Excel, PowerPoint)
HMSA Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about HMSA and has not been reviewed or approved by HMSA.
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Healthcare Strength — Medical and dental coverage are described as solid, with preventive services and select zero‑cost features adding value in recent plan years. Employer-sponsored plans can have affordable premiums in certain groups and broad access options.
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Retirement Support — A 401(k) with company match and potential discretionary contributions forms a strong component of total rewards. Retirement support complements the core medical and dental package.
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Leave & Time Off Breadth — Paid holidays and PTO that increases with tenure provide meaningful time‑off flexibility. Time‑away benefits scale with service length.
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The Company
What We Do
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
