Hawaii Medical Service Association Senior Business Analyst (Claims Operational Support and Analysis ) in Honolulu, Hawaii

Company:Hawaii Medical Service Assn.Job Title:Senior Business Analyst (Claims Operational Support and Analysis )Exempt or Non-Exempt:ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:You’re a self-driven individual and instill a passion for driving excellence. Based on assignment and under minimal direction of management, you utilize your business acumen, acquire process knowledge and apply analytical skills to deliver creative, value-added solutions, organize and coordinate projects, and support operations that will improve or enhance the administration of benefits through claims processing and other supporting functions that includes but is not limited to increasing the level of automation, problem identification and resolution, improving work-flows and procedures, develop and renew reports, develop or revise appropriate documentation, and unit and system testing for all Lines of Business.You will perform a variety of complex tasks to include coaching of staff within unit, identification of issues and data collection, analysis and interpretation, and documentation to develop or substantiate internal and external business proposals. You will be assigned to lead and coordinate business projects of medium to high complexity.Duties and Responsibilities:Industry Research and Analysis and Process Improvement

  • Gathers, reviews and analyzes information to identify trends, issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing.Initiates in the development of strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values. Provides critical assessments of information and data about current trends and issues and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific HMSA actions, including business process improvements.Initiate change and evaluate impact.Conducts ongoing research and analysis to assess changing needs of our industry.Provides quality, objective, and professional analysis.

  • Guiding Project Team and Operational Units

  • Engages and collaborates with project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Supplies or advises in the development of requirements, reports, budgets, and other analyses, and help solve operational issues and roadblocks.

  • Cross-Functional Integration and Communication

  • Works directly with cross-departmental team members to complete tasks and provide status updates. Works with the project team, HMSA departments and external partners to monitor, collect, communicate, and distribute information. Communicates analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations. Conducts presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) to ensure reporting of quality outcomes are consistent and understood.

  • Mentorship, Training and Development

  • Initiates and coordinates implementation and post-implementation activities within department, including but not limited to development of processing and procedure documentation, training materials and employee training as required.

  • Coaches other staff within unit to help develop skills, increase proficiency in role and responsibilities, and drive performance.

  • Develops and initiates team building and unity.

  • Testing

  • Coordinates testing needs and requirements with corporate testing unit.

  • In absence of corporate testing unit may be required to lead and/or coordinate the testing activities which may include gathering and generating test data, identifying test scenarios, status reporting, escalating issues, and performing validation and approval of testing results.

  • Ensures all appropriate processes are followed and documentation is completed as required by acting as quality control checkpoint verifying standards are adhered to.

  • General

  • On a regular, sustained basis, cooperates with other staff members both within and outside the department in the accomplishment of one’s own job duties as well as assisting others in accomplishing theirs; serves as a team player and role model for other employees in the organization by always exhibiting traits of courtesy, caring, helpfulness, and respect; conducts oneself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees.

  • Ability to read, analyze and interpret business documents such as HMSA’s Medical Policy Manual, plan certificates and Guide to Benefits, statistical data, product development memos and documents published by Blue Cross and Blue Shield Association related to program compliance; the Federal and/or state governments pertinent to the business (i.e. Federal Register, CMS guidelines, Hawaii Revised Statutes (H.R.S).

  • Other Duties/Functions

  • Performs other duties and accepts responsibility as assigned.

  • Attends training as needed or assigned.Minimum Qualifications:Bachelor’s Degree and 3 years related experience or equivalent combination of education and experience.EEO/AA/Disability/Vets Employer