Responsible for leading the support of client hardware and software products. Ensures the reliability of the systems operating or network environment, and plans the implementation of new IT service enhancements. Responsibilities include, but may not be limited to, the following. Participates in long-term infrastructure technology strategy and planning for the organization. Participates in defining architecture and technology standards to optimize...
Responsible for leading the support of client hardware and software products. Ensures the reliability of the systems operating or network environment, and plans the implementation of new IT service enhancements. Responsibilities include, but may not be limited to, the following. Participates in long-term infrastructure technology strategy and planning for the organization. Participates in defining architecture and technology standards to optimize...
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...
Lead as an IO Audit and Control Subject Matter Expert (SME) on process and controls. Review and monitor design of IO controls department-wide with the purpose of identifying ineffective or inefficient processes and advising on corrective and/or preventive course of action. Execute and manage compliance due diligence activities (e.g., management testing of controls, process walk-throughs, 3rd party technology risk assessments, contract reviews, et...
Manage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims. Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction. Col...
Design and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are adhering to industry standards and best practices, and support internal and external audits. ...
Oversee and manage accounting operations for HMSA and its subsidiaries, including general ledger and reconciliation activities. Streamline processes and implement efficiencies to optimize financial operations. Ensure accuracy of our financial statements and adherence to Generally Accepted Accounting Principles (GAAP), Statutory Accounting Principles (SAP), and tax laws. Research technical accounting issues as needed. Conduct in-depth financial an...
Lead and manage the function providing oversight of all matters relating to the maintenance and enhancement of internal operations processes and systems to support HMSA's operational and related programs. Governance and relationship oversight of service providers which includes ensuring all new benefits/processes are implemented accurately while corrective actions are also completed according to Service Levels Agreements (SLAs). Project managemen...
Reviews and conducts analysis of financial statements for HMSA and other related entities in an accurate and timely manner. This includes preparation, summarization, and maintenance of source data in various subsystems of financial data. Compiles data that is obtained from other F/A units and other HMSA departments. Conducts analysis by applying the appropriate Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (S...
Broker Management/Contracting. Oversee broker agency and agent contracts, ensuring all licensing and regulatory requirements are met and documented. Maintain and update broker records, including contact information, activation/suspension/termination data, and system access (e.g. unique IDs, security compliance). Manage all agency post-execution contractual downstream deliverables for annual licensing, security, compliance/ethics, liability, et. a...
Coordinates various projects as assigned. Develops system requirements, test plan, test scenarios, test cases, anticipated test results and objectives and acceptance criteria. Also, performs testing, communicates status/concerns to appropriate parties, documents testing results, develops policies and procedures, and implements policies and procedures into production. Monitors and reviews all new project reports to ensure accuracy. Prepares analys...
Conducts implementation and monitoring activities for a variety of HR programs. typically supports multiple teams/ department within a function. Identifies opportunities to enhance the employee experience and partners with management to develop and implement innovative and sustainable solutions. Implements talent management strategies and assists with training on performance management, workforce planning, succession planning, and talent developm...
