Exempt or Non-Exempt: Non-Exempt
Island: Oahu
City: Kapolei
Location: Kapolei
Employment Type: Full Time
Job Summary: Based on assignment by management and under the direction of the supervisor, will learn to support the analysis, coordination and organization of projects related to the enhancement, improvement and/or modification of the claims enhancement system and administration of benefits that includes but is not limited to increasing automation, improving work-flows and related procedures.
Duties and Responsibilities:
Confers with assigned mentoring supervisor and/or System Support Specialist II and other team members on matters pertinent to assigned projects. Tracks projects. Will learn to work as part of a team to identify available options with risk assessment and prepares recommendations for consideration by management based on analysis of project results.
With direction, works with department and internal entities as needed or determined by assignment to gather, clarify and analyze HMSA’s business requirements for non-standard benefit changes, medical policies, new products or provider contracts for their applicability in our claims processing system(s).
Reviews and understands verbal and written complex business requirements from internal customers (i.e., end-users in operational and/or external contact departments) and/or external customers that include but are not limited to providers, groups, government agencies.
With direction, assists in the analysis of business problems, including, but not limited to new benefit changes or products, enhancements to add functionality and/or redesigns of systems to improve efficiency.
With training and direction from the supervisor and/or System Support Specialist II and Manager, will learn to define system functionality for data processing analysts and programmers, including, but not limited to the definition of screens, reports, and internal processing, such as edits, calculations, etc.
May occasionally work as part of a team to define acceptance testing criteria and ensure that the criteria are met before system changes are implemented. Will perform primary unit/system testing as part of training.
Will observe and learn to assist the System Support Specialists in coordinating implementation within department, including, but not limited to development of processing and procedure documentation, training materials and employee training.
Will observe and learn to assist the System Support Specialists in the development, implementation and monitoring of activities that result from assigned project(s) and/or independent analysis. These can include but are not limited to:
changes in the definition of work-flows and procedures
development of reports that result in decreases in claims inventory and aging
identification of claims processing issues that can be addressed by development of problem reports, ISSs, coding or system enhancements
All duties and assignments set forth in this job description will be completed and training assessments, audits will indicate that the trainee is competent to move to System Support Specialist I within one year of hire. Continued employment in the System Support Area is contingent on the successful completion of training within one year of the date of hire.
Manages confidential and proprietary information in accordance with HMSA’s by-laws and Federal Confidentiality Requirements.
Other duties as assigned.
Minimum Qualifications:
Associate’s degree and 1 year related experience or equivalent amount of education and work experience.
Working knowledge of Windows and Microsoft Office.
Effective written and verbal communication skills.
Ability to write reports.
Speak effectively before small groups of employees and various levels of management and auditors.

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