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Hawaii Medical Service Association Verified
Health Insurance, Healthcare

Program Analyst, Federal Employee Program

Honolulu, HIHybridFull TimePosted 2 months agoVisa sponsorship available

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Required skills

  • FEP
  • Utilization Management
  • Case Management
  • Medical Management
  • Disease Management
  • PIP metrics
  • Mahie 2020
  • customer service
  • claims processing
  • policies

Nice to have

  • driver's license
  • automobile access

Role summary

The Program Analyst, Federal Employee Program, will monitor and evaluate FEP program requirements related to Utilization Management, Case Management, Medical Management, and Disease Management. This role involves coordinating cross-functional teams to analyze data, identify opportunities, and make recommendations for process improvements and strategic goals. Responsibilities include supporting daily business operations, ensuring compliance with regulations, analyzing Fraud, Waste, and Abuse (FWA) methodologies, and documenting policies and procedures. The analyst will also travel to industry events to stay informed on FEP landscape developments. A Bachelor's degree and three years of related experience are required, along with proficiency in Microsoft Office.

  1. Monitor, evaluate, educate, and implement FEP program requirements related to Utilization Management (UM), Case Management (CM), Medical Management (MM), and Disease Management (DM) activities to areas within the department for appropriate action. This includes tracking daily operations to ensure deliverables are met and reporting information to FEP Director's Office, various internal committees and other audiences as needed.
  2. Coordinate cross functional teams (including but not limited to HMSA staff and external partners and providers) to collect, communicate and distribute information and conduct quantitative/qualitative analysis to identify areas of opportunity and make recommendations for department/corporate action to support FEP Plan Incentive Program (PIP) metrics and Mahie 2020 strategic goals.
  3. Develop methods to improve daily customer service and claims processing operations and practice standards. This includes, but is not limited to, analyzing business problems, enhancements to add functionality and/or redesign of systems to improve efficiencies and documenting policies and procedures, desktop procedures and workflows to monitor, trend and reflect impact of activities.
  4. Support day-to-day business operations and functions by compiling and reporting on daily activities. This includes identifying trends in operational efficiencies, researching inquiry escalations, responding to secured messages, and administrative tasks.
  5. Support compliance reviews and audits to monitor adherence with federal and state regulations, FEPDO program rules, Office of Personnel Management (OPM) regulatory guidance, and internal policies and procedures. Ensure that "best practices" are implemented, and observations/findings are satisfactorily resolved.
  6.  Identify and protect FEP assets through a detailed analysis, review, and evaluation of Fraud, Waste, and Abuse (FWA) methodology and best practices consistent with HMSA's FWA program. This includes taking a proactive role in identifying, digesting, and communicating trends and assisting in the coordination of resolution for these trends.
  7. Performs all other miscellaneous responsibilities and duties as assigned or directed
  8. Travel to Association-sponsored Plan training programs, meetings, and conferences to understand the current FEP landscape, industry developments, policy or regulatory changes, transformative technologies, operational processes, field service strategies, and other implementing an overall effective FEP program.
#LI-HybridQualifications
  1. Bachelor's degree and three years of related work experience; or equivalent combination of education and related work experience.
  2. Basic working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, PowerPoint, and Outlook.
  3. Must have valid driver's license, access to an automobile with current license, registration, and no-fault insurance.
  4. Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
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