Healthcare Management Administrators

Implementation Specialist

• Coordinate and support new client implementations from handoff through go‑live under established processes and timelines.
• Schedule and facilitate implementation meetings, including internal prep calls, kickoff calls, and routine touchpoints.
• Guide clients through implementation steps, ensuring clarity on next actions, timelines, and responsibilities.
• Serve as a day‑to‑day contact for implementation‑related questions and follow‑ups.
• Maintain implementation plans, trackers, and documentation (e.g., Smartsheet, status trackers, implementation folders).
• Monitor implementation milestones and flag risks or delays to senior implementation team members.
• Ensure deliverables are completed on time and documented appropriately.
• Keep internal stakeholders informed of implementation status and changes.
• Partner with Sales, Account Managers, and internal teams to align on client requirements and sold products/services.
• Coordinate participation from internal subject matter experts during implementation calls as needed.
• Ensure accurate handoff and information sharing across teams throughout the implementation process.
• Maintain accurate and timely documentation in CRM and implementation tools.
• Follow established implementation workflows, templates, and best practices.
• Support process improvement efforts by providing feedback on tools, templates, and client experience.

Implementation Manager

• Independently lead end‑to‑end client implementations, including higher‑complexity or higher‑visibility accounts.
• Own implementation timelines, deliverables, and outcomes, ensuring all activities are completed accurately and on time.
• Facilitate client and broker discussions and decision‑making related to benefit design, services, and implementation approach.
• Proactively manage risks, dependencies, and stakeholder expectations; communicate status and timelines at a strategic level.
• Lead cross‑functional coordination to deliver a seamless, high‑quality implementation experience.
• Troubleshoot complex client‑specific or technical issues and drive timely resolutions with internal teams.
• Maintain strong working knowledge of products, operational capabilities, and implementation processes.
• Identify opportunities to improve implementation tools, workflows, and operational efficiency.
• Serve as a mentor and resource to Implementation Manager I team members, reinforcing best practices and quality standards.
• Maintain implementation plans, trackers, and documentation (e.g., Smartsheet, status trackers, implementation folders).
• Monitor implementation milestones and flag risks or delays to senior implementation team members.
• Ensure deliverables are completed on time and documented appropriately.
• Keep internal stakeholders informed of implementation status and changes.
• Partner with Sales, Account Managers, and internal teams to align on client requirements and sold products/services.
• Coordinate participation from internal subject matter experts during implementation calls as needed.
• Ensure accurate handoff and information sharing across teams throughout the implementation process.
• Maintain accurate and timely documentation in implementation tools.
• Follow established implementation workflows, templates, and best practices.
• Support process improvement efforts by providing feedback on tools, templates, and client experience.

Implementation Manager II

Claims Specialist

• Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts.
• Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis.
• Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes.
• Coordinate Association projects and rule interpretation with Regence and InterPlan Executives.
• Act as key escalation point for Plan-to-Plan issues.
• Cascade InterPlan communications to internal teams.
• Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects.
• Test and validate system updates; refine ITS/BlueCard policies and procedures.
• Conduct root-cause analysis on recurring issues and implement improvements.
• Monitor and communicate InterPlan performance metrics (IPP).
• Track quality and productivity metrics; lead improvement initiatives.
• Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types.
• Serve as the primary escalation point for the most complex, sensitive, or high-impact ITS/BlueCard claim issues.
• Partner with leadership to refine ITS policies, update procedures, and support operational strategy.
• Act as a liaison with BCBS host/home plans and external partners for escalated claim issues.

Lead Claims Bluecard Analyst

Analyst

• Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs
• Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to:
• Identify issues, recommend solutions, and manage situations to resolution.
• Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients.
• Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning.
• Evaluate existing business processes and policies and develop sustainable, measurable improvements.
• Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes.
• Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members.
• Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations.
• Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role.

Payment Integrity Analyst I

Manager

• Lead and manage the day-to-day operations of the Application Development team, including full-stack developers & Data Integration Engineers
• Oversee full software development lifecycle (SDLC) including design, development, testing, deployment, and Tier 3 support
• Drive delivery of scalable, high-quality applications supporting HMA’s core platforms (claims systems, integrations, APIs, internal tools)
• Foster a high-performing team culture focused on accountability, continuous improvement, and engineering excellence
• Hire, mentor, and develop a high-performing team of engineers and technical professionals
• Provide ongoing coaching, performance management, and career development opportunities
• Align team priorities with business goals and ensure clear accountability for outcome
• Ensure seamless integration across HMA’s core platforms (claims administration systems, data pipelines, CRM, and care management tools)
• Oversee development and maintenance of APIs, ETL pipelines, and integration services supporting enterprise data flows
• Collaborate with data and integration teams to ensure performance, data accuracy, and system reliability across platforms
• Ensure production systems meet defined KPIs for performance, stability, and availability
• Establish and monitor metrics related to delivery, system health, and team productivity
• Serve as the escalation point for complex system issues, coordinating resolution across engineering, infrastructure, and vendors
• Drive operational excellence through automation, monitoring, and proactive issue resolution
• Implement and continuously improve Agile/Waterfall development practices, tooling, and delivery frameworks
• Leverage tools such as Azure DevOps and CI/CD pipelines to improve transparency, delivery speed, and quality
• Standardize development practices, code quality, architecture patterns, and documentation
• Ensure all applications meet HIPAA, security, and regulatory compliance requirements relevant to healthcare data and systems
• Establish and maintain development standards, policies, and documentation across the application lifecycle
• Promote secure development practices and data governance across all solutions

Senior Manager, Applications Development

Data Analyst

• Gather and document reporting and analysis requirements from business stakeholders.
• Design and develop analytics solutions tailored to business needs, leveraging appropriate technologies aligned with the best internal practices and system architecture.
• Perform testing, validation, and quality assurance on both self-developed and team-developed analytics solutions.
• Train non-analytics users on how to effectively use analytics tools and report.
• Troubleshoot and resolve issues related to report failures and data inconsistencies.
• Translate solutions across technologies (e.g., SQL to Power Query) and source data from alternative platforms (e.g., Qiclink, Benefit Focus.
• Identify and implement enhancements to existing deliverables, including automation opportunities and process improvements.
• Serve as a backup or understudy for overflow tasks and back-fill coverage across designated departments.
• Collaborate with IT teams and business stakeholders to identify and address issues, risks, and concerns related to data integrity.
• Communicate findings, observations, and recommendations to business stakeholders using clear, business-friendly language.
• Demonstrate deep expertise in analytics technologies (e.g., Python, Power Query, DAX, SQL, R, Fabric, CaseTrakker Reporting) with the ability to teach and mentor other analysts in their effective use. (2 or more)
• Conduct quarterly analytics business reviews with department leaders, presenting insights and performance metrics for your assigned specialty area

Operations Data Analyst II – Healthcare Claims Processing

Account Manager

• Represent Client Success by participating in finalist meetings and implementation
• Owns preparation, delivery and execute of renewal strategy
• Build strong relationships with key stakeholders and demonstrate HMA value
• Recommend products and services relevant to client needs by reviewing data and listening to customer needs through regular touchpoints
• Regularly updates CRM to communicate client and broker activities across the organization
• Brings new insights from industry events, client and broker meetings and competitor information to supplement client success strategy
• Serve as a subject matter expert for client success functions by participating in projects as needed

Procurement

• Independently coordinate RFPs, onboarding, renewals, and amendments for assigned vendors.
• Ensure timely completion of vendor workflows and documentation requirements.
• Recommend improvements to vendor management processes and templates.
• Conduct thorough and proactive spend analysis including year-over-year changes, trend identification, fair market research and cost drivers.
• Prepare negotiation support materials outlining spend levels, contractual fees, and potential savings opportunities.
• Collaborate with Finance and business owners to evaluate pricing structures and service tiers.
• Perform vendor risk assessments, gather evidence, and document results with moderate independence.
• Evaluate vendor controls and escalate concerns or gaps to senior analysts for remediation planning.
• Maintain accurate and current vendor risk profiles and scoring logic.
• Facilitate multi-stakeholder discussions for vendor onboarding or renewal activities.
• Track action items, monitor timelines, and ensure deliverables remain on schedule.
• Contribute to vendor performance reviews, service plans, and remediation follow-up.
• Serve as a secondary reviewer for contractual terms, identifying pricing risks, service gaps, or misalignments.
• Draft recommended changes to financial terms or cost-related provisions prior to Legal review.