Healthcare Management Administrators

• 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.

• 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

Role Description The Payment Integrity Analyst ensures assigned payment integrity programs are delivered efficiently and with high quality. Using claims expertise, program knowledge, and analytics capability, this person will provide the day-to-day management of assigned programs which may include, but aren’t limited to, our CMS Demand Case program and our Subrogation program. They will research case questions, resolve issues, identify process and program improvements, and ultimately contribute to the delivery of a strong portfolio of payment integrity programs. What YOU will do: - 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 knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role. Qualifications - High School Diploma required. - ICD-10 & CPT experience required. - 3-5+ years of claims processing experience within the insurance industry. - 2+ years data entry experience. - Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data. - Able to manage a complex daily queue and prioritize workload effectively. - Skilled in identifying root causes of issues through detailed investigation and inquiry. - Able to analyze impacts of potential actions or decisions to determine the optimal choice. Compensation The base salary range for this position in the greater Seattle area is $73,000-$81,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Benefits - Seventeen (IC) days paid time off (individual contributors). - Twelve paid holidays. - Two paid personal and one paid volunteer day. - Company-subsidized medical, dental, vision, and prescription insurance. - Company-paid disability, life, and AD&D insurances. - Voluntary insurances. - HSA and FSA pre-tax programs. - 401(k)-retirement plan with company match. - Annual $500 wellness incentive and a $600 wellness reimbursement. - Remote work and continuing education reimbursements. - Discount program. - Parental leave. - Up to $1,000 annual charitable giving match. How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in-person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. Company Description HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

Role Description As our Senior Manager, Application Development, you’ll help bring HMA’s technology vision to life, leading the teams and systems that keep our business running and evolving. From claims processing to data integrations, you’ll oversee the applications that sit at the core of what we do. This role is equal parts leadership, strategy, and hands-on technical guidance. You’ll collaborate across teams to modernize our systems, embrace cloud-native solutions, and build scalable platforms that support where we’re headed, not just where we are today. What YOU will do: - Application Development Leadership - 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. - Platform & Integration Oversight - 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. - Delivery, Operations & KPIs - 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. - Agile Execution & Process Optimization - 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. - Governance, Compliance & Security - 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. Qualifications - Bachelor’s degree in Computer Science, Engineering, or Business Administration preferred. - 5+ years of leadership experience in managing high performing teams. - 10+ years of IT work experience leading development in enterprise environments with complex integrations. - Direct experience managing applications and/or systems management. - Expert knowledge of technical design approaches, solution design and architecture. - Expert knowledge of system and software quality assurance best practices and methodologies. - Expert knowledge of SDLC, Agile/SCRUM best practices and methodologies. - Experience working with Business Analysis and QA teams to ensure proper handoff and collaboration during SDLC. - Advanced data integration knowledge and troubleshooting experience. - Excellent project management and leadership skills with customer service focus. - Knowledge of, or desire to learn, applicable data privacy practices and laws. - Leadership and management skills with an orientation for action and results, with a proven ability to build, manage, and retain high performing successful collaborative work teams. Technical Background - Design and/or development experience with .NET, C#, ASP.NET, Web Services. - Strong background in object oriented development techniques, design patterns. - Experience with concurrent development source control (Git) and continuous integration. - Experience with development tools, including Docker, Jenkins, Azure DevOps, GitHub, Hangfire, Cron. - Experience with QA automation framework and tools. - Experience with cloud platforms, Azure experience is preferred. - Experience in Azure based web application development involving (Microservices, App Services, Service Bus). - Experience with SQL platforms (e.g. SQL Server, Azure SQL, MySQL, Mongo DB). - Experience troubleshooting data integration pipelines, performance tuning, and validation of data exports. - Experience with AI development, developer governance, and spec drive AI development. Compensation The base salary range for this position in the greater Seattle area is $184,000-$231,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Benefits - 22 (IC) days paid time off (individual contributors). - Twelve paid holidays. - Two paid personal and one paid volunteer day. - Company-subsidized medical, dental, vision, and prescription insurance. - Company-paid disability, life, and AD&D insurances. - Voluntary insurances. - HSA and FSA pre-tax programs. - 401(k)-retirement plan with company match. - Annual $500 wellness incentive and a $600 wellness reimbursement. - Remote work and continuing education reimbursements. - Discount program. - Parental leave. - Up to $1,000 annual charitable giving match.

Role Description The purpose of the role is to continuously improve HMA’s Analytics function through data quality initiatives and automation. This role will work to identify, test, and implement automated reports and processes that are significant to business processes and internal stakeholders. Acting as the Subject Matter Expert for internal stakeholders, this position will also assist its customers with reporting-related questions and troubleshooting and will conduct research as needed to determine the appropriate responses. This role requires experience utilizing claims processing software such as Facets, Qiclink, Benefit Focus, Javalina, HealthEdge, etc. What YOU will do: - 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. - Conduct quarterly analytics business reviews with department leaders, presenting insights and performance metrics for your assigned specialty area. Qualifications - Bachelor’s degree or equivalent experience required. - 3-5+ years’ previous experience with reporting and data analysis using SQL and PowerBI. - Certification in PowerBI preferred. - Proven success creating and maintaining data visualization tools including PowerBI. - Expert level skills within Microsoft Excel and the ability to manipulate data with ease. - Must be a critical thinker and very analytical in order to synthesize data and troubleshoot issues. - Great communication skills in order to interact with stakeholders and efficiently gather requirements. - Resilient, adaptable, and have the ability to grasp new ideas and concepts quickly. - Mastery of time management and ability to work on multiple projects simultaneously, stay organized and maintain a keen attention to detail. - Experience in the health care analytics industry, including payer/TPA models strongly preferred. Application Note When applying, please include the phrase “What stood out to me about this role is…” somewhere in your application. Compensation The base salary range for this position in the greater Seattle area is $111,000-$136,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Benefits - Seventeen (IC) days paid time off (individual contributors). - Eleven paid holidays. - Two paid personal and one paid volunteer day. - Company-subsidized medical, dental, vision, and prescription insurance. - Company-paid disability, life, and AD&D insurances. - Voluntary insurances. - HSA and FSA pre-tax programs. - 401(k)-retirement plan with company match. - Annual $500 wellness incentive and a $600 wellness reimbursement. - Remote work and continuing education reimbursements. - Discount program. - Parental leave. - Up to $1,000 annual charitable giving match. How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in-person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. Disclaimer HMA requires a background screen prior to employment. Protected Health Information (PHI) Access: Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know basis and according to HMA’s standard policies and procedures. HMA is an Equal Opportunity Employer.

• 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

Role Description As an Account Manager at HMA, you are the trusted partner for both clients and brokers building strong, lasting relationships and ensuring everyone feels supported. You’ll work closely with clients who have self‑funded health plans, guiding them through the complexities and helping them maximize the value of their strategies. At the same time, you’ll manage broker relationships, keeping them aligned and empowered to deliver the best outcomes for their clients. Beyond retention and engagement, you’ll serve as the clear voice of clients and partners within the organization, making sure their needs are represented and acted on. What YOU will do: - Represent Client Success by participating in finalist meetings and implementation. - Own preparation, delivery, and execution 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 update CRM to communicate client and broker activities across the organization. - Bring 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. Qualifications - BA degree in healthcare related field, communications, business administration preferred. - WA State Agents License, Life & Disability or other professional designation (e.g., CEBS, HIAA) preferred upon hire. May be completed within first 90 days upon hire. - 1-2 years’ experience in the health insurance industry. - 1-2 years working directly with clients/brokers. - 2 years of account management experience. - Extensive knowledge of ERISA, Benefit Plan Management, Self-Funded Benefit Plans, and Stop Loss. - Strong written and verbal communication skills. - Professional presence and appearance. - Ability to engage in community/networking opportunities outside of normal business hours. Requirements - The base salary range for this position in the greater Seattle area is $90,000-$100,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. - Performance-based incentive bonus(es) is available. Benefits - Seventeen (IC) days paid time off (individual contributors). - Eleven paid holidays. - Two paid personal and one paid volunteer day. - Company-subsidized medical, dental, vision, and prescription insurance. - Company-paid disability, life, and AD&D insurances. - Voluntary insurances. - HSA and FSA pre-tax programs. - 401(k)-retirement plan with company match. - Annual $500 wellness incentive and a $600 wellness reimbursement. - Remote work and continuing education reimbursements. - Discount program. - Parental leave. - Up to $1,000 annual charitable giving match.

• Conduct detailed audits of medical claims and itemized bills to ensure accuracy and compliance with coding standards (ICD-10, CPT, HCPCS). • Identify and document billing errors, upcoding, unbundling, and other discrepancies. • Review high-dollar claims and complex cases for potential overcharges or inappropriate billing. • Validate diagnosis and procedure codes against medical documentation. • Ensure coding aligns with payer policies, CMS guidelines, and industry best practices. • Support cost containment initiatives by identifying opportunities for claim reductions or denials. • Assist in the development of audit strategies to target high-risk claims. • Stay current with changes in coding regulations, payer guidelines, and healthcare laws. • Participate in internal quality assurance programs to ensure audit consistency and accuracy. • Provide feedback and training to internal teams on coding and billing best practices.

• The Case Manager Nurse demonstrates skill in core nursing processing including assessment, planning, implementation, coordination, monitoring and evaluation of proposed treatment plans. • Provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions. • Evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination. • Perform Utilization Management and apply first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility. • Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay.

Role Description The Case Manager provides holistic primary Care Management for all client groups including Medical and Managed Behavioral Health services, monitoring of member utilization and claim patterns and ongoing case management for complex care. Case Managers collaborate with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations. What YOU will do: - The Case Manager Nurse demonstrates skill in core nursing processing including assessment, planning, implementation, coordination, monitoring and evaluation of proposed treatment plans. - Provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions. - Evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination. - Perform Utilization Management and apply first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility. - Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay. Qualifications - Current Baccalaureate prepared (Preferred) in Nursing or Community/Public Health - 1-3+ years of clinical nursing experience - Active Certification or RN clinical license, as applicable to the degree - Strong experience in clinical practice with diverse diagnoses - Developing leadership skills - Problem solving and critical thinking skills - Knowledge of Case Management and Utilization Review processes - Excellent, client-facing verbal and written communication skills - Ability to be self-motivated and self-directed - Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets - Behavioral health experience preferred - Proficiency with Microsoft Office applications (Outlook, Word, DOSS) Requirements - The base salary for this position in the greater Seattle area is $85,000-$99,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. - Performance-based incentive bonus(es) is available. - HMA requires a background screen prior to employment. - Protected Health Information (PHI) Access: Employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures. Benefits - Seventeen (IC) days paid time off (individual contributors) - Eleven paid holidays - Two paid personal and one paid volunteer day - Company-subsidized medical, dental, vision, and prescription insurance - Company-paid disability, life, and AD&D insurances - Voluntary insurances - HSA and FSA pre-tax programs - 401(k)-retirement plan with company match - Annual $500 wellness incentive and a $600 wellness reimbursement - Remote work and continuing education reimbursements - Discount program - Parental leave - Up to $1,000 annual charitable giving match