The Role
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.
Summary Generated by Built In
Job Summary & ResponsibilitiesPreferred Qualifications
- Cross-Functional Project Team Leadership and Participation: Lead project staff and subject matter experts with the planning and implementation of project and sub-project work efforts.
- Lead, coordinate, facilitate, and/or participate in cross functional teams to plan and complete complex corporate projects, such as health systems negotiations, government mandates, and corporate payment initiatives.
- Bring a whole-company perspective to ensure the delivery of holistic department and/or corporate solutions.
- Provide documentation and training on data elements, systems, or analytic methodologies to other analysts within the department and other units.
- Manage ongoing project dynamics to ensure successful completion and impact.
- Department and Division Project Management: Manage project deliverables based on business needs and assigned responsibilities.
- Gather business requirements to determine timelines.
- Conduct ongoing reassessment to reprioritize as needed and make corrections to assure measures meet short- and long-term goals.
- Ensure project progresses on schedule within prescribed budget guidelines.
- Document procedures that support analysis for corporate strategies.
- Perform cost/benefit analysis that supports business operations and project management. Assist to define solutions that support business flows through use of workflow design/redesign
- Coordinate and undertake response to requests from executives, providers, and internal HMSA departments to support reimbursement methodology evaluations, which could lead to potential changes mandated by government entities.
- Provide training, mentoring, and guidance to Financial and Business Analysts and Project Leads in the department to ensure analysis framework, data elements, execution, reporting, and presentations are appropriate, accurate, and concise for internal and external audiences and all levels of staff.
- Data Management, Research and Analysis: Conduct research, design and update current data workflows that support multiple lines of business' health plan requests.
- Develop reporting tools and maintain various database programs, including financial and clinical data, to analyze, track, review and support a variety of medical management activities.
- Based on derived results, translate data and create analytical presentations using tables, graphs, charts, written report or other methods. Identify the best resource of data; how to accurately pull the data and validation of the data.
- Ensure current reporting is capturing all data for encounter submissions to meet government entity requirements, which accounts for derived revenues from those government entities.
- Utilize advanced technical skills in information applications, database summary and applications, and data analysis for end-user systems development with business knowledge and experience of HMSA requirements and functions.
- Data Systems & Applications Management: In conjunction with the direction of Executive staff, will evaluate and participate in possible future tools that will lead HMSA in implementing strategies for new reimbursement methodologies to help shape the corporate goals.
- Analyze existing applications and/or designs new computing services or systems to complete data analyses and reporting required to meet changing goals. Incorporates computing concepts, theories, new technologies, and architectures and applies knowledge of computing trends, company business objectives, and customer requirements.
- Evaluate system options; make recommendations, providing input and technical guidance. Develop necessary project plans for implementation to lead and coordinate problem tracking, resolution, and verification testing, as needed.
- Evaluate opportunities to automate current manual processes. Monitor Payment Transformation validation processes.
- Train department analysts to increase core systems knowledge and HMSA best practices.
- Cross-Functional Integration and Communication: Create and foster working relationships with internal staff and external business partners to complete deliverables.
- Represent the Finance Division on the Data Council for the Corporate Data Strategy Priority. Attend and actively participate in meetings to vote on policy, strategy, and data changes.
- Accountable for overall health and quality of data assets for the respective domain. Alignment with Executive Leadership Team and establishing roll out plan for domain data managed in the EDP. Represent data domains on Data Governance Council Data definitions and standards for critical data of the domain. Adherence to data governance policies and processes. Presenting investment needs for the domain to Executive Leadership Team.
- Collaborate and work with internal subject matter experts and support staff.
- Design reports to deliver data and information that will address and improve business needs.
- Communicate task specifications and status in a clear and concise manner.
- Collaborate with other staff and management to complete assigned duties and objectives, facilitate communications and resolve problems and issues quickly, tactfully, and positively.
- Present data and information in a clear, concise, and appropriate-to-the-audience manner.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
- Bachelor's degree and five years of related experience; or equivalent combination of education and work experience.
- Strong verbal and written communication skills.
- Proficiency in problem solving and data collection, analysis, and interpretation.
- Knowledge of basic relevant statistical analyses.
- Knowledge of data analytics & process improvement.
- Knowledge of data governance principles
- Basic working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, PowerPoint, and Outlook.
Skills Required
- Bachelor's degree and five years of related experience or equivalent combination of education and work experience.
- Strong verbal and written communication skills.
- Proficiency in problem solving and data collection, analysis, and interpretation.
- Knowledge of basic relevant statistical analyses.
- Knowledge of data analytics and process improvement.
- Knowledge of data governance principles.
- Basic working knowledge of Microsoft Office applications (Word, Excel, PowerPoint, Outlook).
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.
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