Hawaii Medical Service Association Senior Business Analyst II in Honolulu, Hawaii
Company:Hawaii Medical Service Assn.Job Title:Senior Business Analyst IIExempt or Non-Exempt:ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:Function as a senior business analyst that has a deep understanding of HMSA’s drug benefit which allows the ability to provide subject matter expertise and guide project teams and operational units in their planning, research, analysis, project management and communication efforts necessary to develop, modify and implement successful programsDuties and Responsibilities:
Project Management and Implementation:
Manage project activities related to drug rider benefits; coordinating and implementing clinical initiatives, PBM solutions, and/or pharmacy benefit operations and improvements, ensuring timelines and requirements are met
Review and edit requirements, specifications, business processes and recommendations related to initiatives or proposed solutions.
Provide quality, objective, and professional analysis of business needs and PBM capabilities & limitations
Conducts research, evaluation of measures and value assessments of initiatives and/or programs.
Coordinate and facilitate planning, tracking and install of business requirements
Assess compliance with Federal and State regulations, internal policies, procedures and workflows
Manage deliverables and timelines.
Resolve department project issues or issues as assigned.
Identify organizational strengths and weaknesses and suggests areas of improvement (program development opportunities).
Proactively conduct process improvements within the department and/or the PBM to ensure operations are efficient
Facilitate communication and prepare project status reports for management, partners, business owner, executive sponsor, and project team or others as required
Benefit Design & Delivery:
Work with internal HMSA staff to understand the intent of the update/change requested. Work with the Pharmacy Benefit Manager (PBM) to implement the change
Analyzes business problems, including, but not limited to new benefit changes or products, enhancements to add functionality and/or redesigns of systems to improve efficiency
Implement, test and evaluate changes made within the PBM
Define acceptance testing criteria and ensure that the criteria are met before system changes are implemented
Maintain PBM system functionality to ensure operational efficiency
Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validation; report monitoring and/or live claim review
Pull and analyze reports to identify trends, issues and potential problems related to PBM claims processing
Prepare the reports for internal or external consumption
Present recommendations for resolution
Prepare implementation plan for resolution and execute
Designs program reporting templates or other tools as needed.
Ensure HMSA meets performance standards state by employer groups, Blue Cross Blue Shield Association, or government regulations, in addition to internal policies, procedures, workflows or business requirements
Cross-Functional Integration and Communication:
Work directly with cross-departmental team members including the PBM to complete tasks, facilitate communication, and provide status update
Work with the project team, HMSA departments and external partners to monitor, collect, communicate, and distribute information
Communicate analysis, assessments, recommendations and completed work product through professional written or oral reports and presentations
Cooperate with other staff members to accomplish job duties as well as assisting others in accomplishing theirs
Assist with vendor management and evaluation.
Training other analysts and staff.
Other managerial duties as assigned.
Other duties as assigned:
Serve as a team leader and role model for other employees in the organization by always exhibiting traits of courtesy, caring, helpfulness, and respect; conducts oneself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees.
Bachelor’s degree and 4 years of related work experience; or equivalent combination of education and work experience.
Proficiency in PC applications and Microsoft Office suite products.
Knowledge/skills in project management
Proficiency in issues identification, resolution, and program operations
Working knowledge of database and spreadsheet programs.
Strong oral and written communication skills with the ability to provide information in a formal presentation setting (e.g., demonstrated presentation skills).
Strong organization and time management skills to work on multiple projects simultaneously and meet project deadlines.
Strong interpersonal skills