Data Management. Reviews data sources and preps needed data. Identifies and communicates issues, limitations, and risks with data sets/reports. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, goes back to source if problems are found, and identifies other options/alternatives if problems cannot be resolved. Performs review of data to ensure comp...
Data Management. Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, goes back to source if problems are found, and identifies other options/alternatives if problems cannot be resolved. Performs review of data to ensure completeness/accuracy/timeliness for the purpose of the analysis. Maintains tables that...
Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the following. Participates in the project planning and analysis process with clients, business analysts and team members. Assist in sizing and the development of timelines. Identifies and refines system requirements. Complies with architecture processes, principles, policies and standards. Assi...
Product Ownership & Agile Delivery. Develop, maintain and communicate product vision & roadmaps, ensuring alignment with organizational goals, technology trends, and customer needs. Represent the voice of the customer and business stakeholders within the Scrum team, ensuring user stories deliver measurable value. Own and evolve the product backlog, prioritizing based on performance analytics, stakeholder input, sprint outcomes, and shifting busin...
Collect, analyze, and utilize data and feedback related to the Provider Call Center to provide audit oversight upon predefined contractual criteria and identify opportunities to improve operations between HMSA and the vendor team. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO). Compile reports about incidents, events, and updates regarding provider HHIN a...
Lead EAO Processes. Work with stakeholders and leadership from across the organization to ensure initiatives are moving from development to execution (through phased framework). Support initiative leads to understand process, business case requirements, and support teams needed to move through framework. Develop and maintain plans, timelines, governance and scope documents for EAO. Manage EAO Operations. Manage the EAO meetings to ensure successf...
Leads team to execute on key corporate/enterprise-wide initiatives. Support Program Managers to lead the planning, execution, and delivery of high-impact programs, ensuring alignment with organizational objectives and stakeholder expectations. Ensure team works collaboratively with program leads to assure program results are achieved, is delivered timely, within budget, and in alignment with enterprise goals. Select, develop, manage and mentor a ...
Data Governance Expertise and Processes. The Data Governance Analyst will coordinate and contribute to the management of governance processes, including reviewing existing processes and assisting in the implementation of new ones aligned with corporate priorities and initiatives. This includes. Utilizing and supporting data governance and analytical tools to evaluate data quality, applications, and workflow functions. Informing workflows for data...
Lead provider performance management activities. Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement and drive continuous improvement. Oversee and manage staff. Manage the performance governance aspects of provider services contracts. These activities include. Enforce compliance with the contractual SLAs and deliverables. Review a...
Stakeholder Support. Support product managers by eliciting stakeholder input, documenting product needs, and participating in discussions across the product lifecycle. Assist with stakeholder communications to clarify goals, document decisions, and follow up on action items. Learn to understand the vision, goals, and operational needs of business units. Solution Design. Assist in eliciting and translating business requirements into user stories, ...
Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, and accreditation standards. Develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance. Collaborate with external partners, IT, Claims Operations, Provider Ser...
Data Analysis and Reporting. Conduct high quality, objective analysis to support performance optimization and strategic initiatives. Collect, interpret, and evaluate Key Performance Indicators (KPIs) and related information to identify trends, issues, root causes, and potential problems while proactively recommending solutions that support performance optimization including process improvement. Design and build reports, dashboards and visualizati...
