Ensure that Self Direct Providers (SDP) and members are enrolled in Acumen and are trained to use the Electronic Visit Verification System (EVV). Audit enrollment for completion. Train new Health Coordinators (HC) in Acumen's EVV system as it relates to SD. Track and monitor monthly submission of time entries. Monitor EVV time punches. Contact SDPs regarding incomplete ti

Product Strategy & Portfolio Management Own the end to end product strategy for the assigned segment, including benefit design, competitive positioning, rate considerations, and portfolio optimization. Establish short and long term product goals in partnership with leadership; translate strategy into actionable initiatives and recommendations. Conduct regular portfolio an

Ancillary Product Strategy & Portfolio Management Define and execute the ancillary portfolio strategy and roadmap, while owning assigned products and benefits. Make prioritization and lifecycle decisions (launch, refresh, bundle, rationalize, sunset) and execute approved changes. Identify, design, and implement opportunities to expand or optimize offerings and integrate a

Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and highly complex issues that include medical or payment policy questions and provider appeals. Resolve root problems to ensure compliance with contract terms and servicing goals. Communicates directly with providers and office staff

Perform FWA incident oversight and SIU staff development activities Provide direct oversight to other SIU staff by reviewing and providing feedback to Investigators for written correspondences and regulatory referrals. Provide day to day advice/guidance to SIU staff on FWA incidents including decisions to open and/or close SIU incidents. Create, update and present trainin

SIU case investigation management, resolution and prevention Manage complex FWA case investigations, collaborate with federal, state and law enforcement entities, and provide applicable notifications as required. Conduct pro active FWA case investigations and resolutions. Maintain extensive documentation and evidence for SIU cases. Recommend and implement preventive measu

Job Description Evaluation Administers job description process Reviews job evaluation requests for new or revised job descriptions to determine appropriate job leveling and FLSA exemption status. Utilizes job evaluation criteria and available salary market data. Reviews job description content, evaluation questionnaires and job equity guidelines to ensure evaluation metho

Provides general production support Monitor daily production performance and inventory levels as assigned. Conduct data and trend analysis to identify areas of improvements. Triage daily production issues. Recommend and implement interim workarounds. Recommend solutions and/or corrective actions for issues that are brought to the attention of the unit. Create and update o

Independently research and design original materials from beginning concept to final product. Interpret/understand project requirements from job request form and/or meetings with Communications Program Manager and/or customer. Lead design concept sessions with design team, comm staff and business partners as needed. Design and create materials according to project specs a

CUSTOMER EXPERIENCE Provide all customers with an exceptional customer focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members and other consumers by becomin

a. Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by Researching and collaborating with other units or departments to find a solution Accurately updating member records Contacting external partners who provide services for/to HMSA

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 performa

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 incl

Responsible for managing all aspects of the planning, execution, controlling, and closure of projects/programs. Responsibilities include, but are not limited to, the following Receives high level business requirements and develops detailed requirements. Prioritizes efforts and maintains and manages inter and intra project dependencies. Refines resource requirements and fo

Mentor servicing representatives to ensure the best customer experience by supporting representatives after they complete classroom training; completing quality assurance audits that ensure timeliness, accuracy, professionalism, and an optimal customer experience; and providing timely, relevant coaching in professional and constructive manner. Be available at all times fo