The Role
Analyzes and forecasts payer revenue streams, including premium revenue and risk adjustment payments. Develops financial models, performs variance analysis, interprets enrollment and financial data, and identifies revenue optimization opportunities. Ensures compliance with regulatory and internal reporting requirements, maintains reconciliation and audit documentation, recommends process improvements, collaborates with actuarial, finance, compliance, and operations teams, and mentors junior analysts.
Summary Generated by Built In
Job Summary & ResponsibilitiesPreferred Qualifications
- Reporting, Research & Analysis
- Analyzes and forecasts premium revenue, risk adjustment payments, and other revenue streams related to lines of business with minimal guidance.
- Interprets financial and enrollment data from internal and external sources, identifying opportunities and problems compared to anticipated outcomes.
- Evaluates financial data needs and identifies and implements solutions for program driving accurate coding and documentation to optimize revenue.
- Develops and maintains financial models to assess the impact of regulatory changes, enrollment trends, and market dynamics on revenue.
- Variance analysis: identify and explain variances between actual and projected revenue, providing actionable insights to leadership.
- Collaborates with actuarial, finance, compliance and operations teams to ensure accurate revenue recognition and reporting.
- Compliance & Documentation
- Ensure all revenue analysis and reporting adhere to internal policies and regulatory guidelines, and recommends strategic alternatives.
- Develops, maintains, and analyzes appropriate documentation of desktop procedures for reconciliation and audit needs.
- Builds and maintains in-depth knowledge of revenue structures and regulations and conceptual knowledge of related activities.
- Leadership & Continuous Improvement
- Recommends and implements process enhancements to improve the accuracy and efficiency of revenue analysis.
- Mentors junior analysts and may be assigned project lead requiring some resource planning assignments.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
- Bachelor's degree and five years of related experience; or an equivalent combination of education and related work experience.
- Strong presentation skills to peers, management and executive staff.
- Working knowledge of Medicare Advantage, Medicaid, and/or ACA revenue cycles for payers.
- Strong Working knowledge of claims, health plan financial data, and health industry structure.
- Advanced knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
Skills Required
- Bachelor’s degree and five years of related experience, or an equivalent combination of education and related work experience
- Strong presentation skills with peers, management, and executive staff
- Working knowledge of Medicare Advantage, Medicaid, and/or ACA revenue cycles for payers
- Strong working knowledge of claims, health plan financial data, and health industry structure
- Advanced knowledge of Microsoft Office applications, including Word, Excel, Outlook, and 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.
