Health Insurance Plan Builder
Are you looking for a challenging position that combines your healthcare claims payment experience with your project management skills? Would you like to work in an environment where your abilities will be valued and you will have the opportunity to make significant contributions?
If so…
We want to speak to you about a career at HMA.
HMA is a Third Party Administrator conveniently located in Bellevue in need of a dynamic, innovative Plan Builder in our Claims Operations Department. We are a wholly owned subsidiary of Regence BS, and have been here for over 25 years. HMA serves over 100,000 employee lives on behalf our self-insured group health plans. We offer a generous benefit package, competitive salaries, profit sharing, and a friendly welcoming culture. Here is your chance to work alongside and be part of a vibrant, fun and knowledgeable team of professionals with diverse backgrounds.
Under the direction of the Manager, Consumer Directed Healthcare, this position is responsible for benefit plan building, plan document reviews and benefit recommendations in collaboration with our Client Services and IT departments. The individual in this position must have a detailed understanding of all major system modules. This position is responsible for the analysis of group plans and data; analysis and documentation of products in a test environment through implementation; and for analysis of new upgrades and enhancements to software, as well as testing the enhancements and ensuring a smooth launch to the production environment. Responsibilities include defining functional requirements and performing acceptance testing. User training on new features is expected.
Essential Functions:
- Maintain Plan parameters in specialized database for all new groups, renewals and changes. Includes the enhanced testing and application of auto adjudication. Review all plan building changes for accuracy and testing.
- Notify management of any proposed changes to plans and the effect on client and HMA.
- Make benefit recommendations for groups upon renewal, and for new groups as appropriate in conjunction with Client Services.
- Document procedures, test results and user training appropriately.
- Analysis of new system upgrades and functionality of applications, including recommendations for installation, testing, user training and implementation.
- Maintain knowledge of various business operations, particularly Claims, so workflow and procedure impacts due to automation are understood and facilitated.
- Other duties as assigned.
Successful Candidate will have:
- 2 years of claims adjudication experience in a healthcare environment
- 2 years of project management experience
- Extensive experience working with health plan benefits structures
- Superior analytical and problem solving skills
- Excellent time management and communication skills
- Team player able to work in a self directed position involving a high degree of complexity
- Proficient with MS Office Suite and Excel
Healthcare Management Administrators (HMA) believes in delivering superior value to our many self-funded Northwest clients by combining competitive rates with superior service. If you would like to learn more about our organization, please E-mail your resume, cover letter and salary history. Faxed resumes are welcome at 305/574-0443.