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Plan Performance Analyst I

2 months ago

Honolulu, Hawaii, United States HMSA Full time

Operational Quality Specialist

**Job Summary**

We are seeking a highly detail-oriented Operational Quality Specialist to assist with and/or perform operational quality measures for limited lines of business. The successful candidate will be responsible for reviewing provider contracts and rates, comparing them to plan benefits, and ensuring HMSA's payment or denial aligns with both the provider contract terms and member benefits.

**Key Responsibilities**

* Assist with and/or perform operational quality measures for limited lines of business
* Review provider contracts and rates to ensure HMSA's payment or denial aligns with both the provider contract terms and member benefits
* Apply HMSA's medical policies to equate diagnosis to procedures listed on claims
* Apply basic knowledge of HMSA's Claims, Customer Service, and Enrollment Systems
* Attend meetings with staff/management in multiple departments to observe/support issue resolution during the review

**Requirements**

* Demonstrate ability for critical thinking under guidance or supervision
* Keep abreast of changes to HMSA products by reviewing memos and other documentation distributed to the unit as well as changes in BCBSA Guidelines
* Perform all other miscellaneous responsibilities and duties as assigned or directed

**What We Offer**

* Opportunity to work with a dynamic team in a fast-paced environment
* Professional development and growth opportunities
* Competitive compensation and benefits package

**How to Apply**

If you are a motivated and detail-oriented individual with a passion for quality and excellence, please submit your application.