The Role
Manage encounter submission program including coordination with LOB and finance, ensure compliance with risk-adjustment rules, oversee data reconciliation and vendor reporting, implement solutions, lead and develop team, produce internal/external reports, and drive continuous improvement.
Summary Generated by Built In
Job Summary & ResponsibilitiesPreferred Qualifications
- Encounter Submissions Management
- Communicates with LOB leads and Governance Finance Director on the necessary information and context for strategic business decision making.
- Establishes schedule for meetings and deliverables to complete needs of all 3 lines of business encounter submissions.
- Supports audits of encounter data and minimizes risks of findings from submission activities.
- Ensures encounter submission data is meeting requirements for risk adjustments as set by relevant government entities.
- Manages implementation of new solutions as needed.
- Oversees data reconciliation and research. Resolves issues with encounter data reported through vendor partners recommending or implementing corrective actions.
- Analyzes project objectives, data sources, methodology, and data summaries and findings.
- Responsible for production, delivery, and efficacy review of reports for internal and external audiences.
- Coordinates and prioritizes activities with internal and external staff for implementation and monitors work for accuracy.
- Program and Team Management
- Coordinates work of the encounters submission workgroup, ES team, and ES vendor(s).
- Provides guidance and development to team members.
- Responsible for performance management and staffing.
- Builds business case for additional resourcing needs.
- Delegates some leadership to senior analysts and oversees outcomes and communication.
- Continuous Improvement
- Develops strategies to improve encounter submission passthrough and communication of opportunities to business owners.
- Creates culture of continuous improvement and a working environment to support encounter submissions, financial analysis, and reporting for Government Finance.
- Subject Matter Expertise
- Monitors and evaluates changes in the external/internal environment, making changes to staffing and workflows to adapt.
- Forecasts gaps in SME and requests investments in internal or external resourcing.
- Develops and implement changes to processes and procedures that optimize revenue.
- Documentation
- Ensures complete documentation of program policies and procedures.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
- Bachelor's degree and four years of related experience; or an equivalent combination of education and related work experience.
- One year of supervisory or management experience.
- Effective verbal and written communication skills.
- Proven success with system implementation and analytical work.
- Intermediate working knowledge of Microsoft Office applications, including but not limited to Outlook, Word, and Excel.
- Strong knowledge of Information Systems.
Skills Required
- Bachelor's degree and four years of related experience or equivalent combination of education and experience
- One year of supervisory or management experience
- Effective verbal and written communication skills
- Proven success with system implementation and analytical work
- Intermediate working knowledge of Microsoft Office applications (Outlook, Word, Excel)
- Strong knowledge of Information Systems
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.
