Claims Operation Specialist

4 weeks ago

Honolulu, United States HMSA Full time
  1. Collect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO). Compile reports about incidents, events, and updates regarding claims processing issues and conflicts.
    • Gathers, reviews, and analyzes information to identify trends, issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing. This includes reviewing and validating new implementations.
    • Initiates in the development of strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values. Provides critical assessments of information and data about current trends and issues and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific HMSA actions, including business process improvements.
    • Initiate change and evaluate impact.
    • Conducts ongoing research and analysis to assess changing needs of our industry.
    • Provides quality, objective, and professional analysis.
  2. Communicate with vendor and internal stakeholders to quickly and accurately obtain or provide information regarding claims processing updates:
    • Works directly with cross-departmental team members to complete tasks and provide status updates. Works with HMSA departments and external partners to monitor, collect, communicate, and distribute information.
    • Communicates analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations. Conducts presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) and our vendor partner to ensure reporting of quality outcomes are consistent and understood.
    • Communicate process changes to vendor to stay current with government and commercial health plans, agencies, and other entity's guidelines.
    • Engages and collaborates with staff and subject matter experts with the planning and implementation of project and sub project work efforts. Supplies or advises in the development of requirements, reports, budgets, and other analysis, and help solve operational issues and roadblocks.
  3. Organize, maintain, and keep readily accessible, all references, documents, policies, and procedures related to claims to ensure correct application of contract benefits between HMSA and Managed Service Provider(s).
    • Ability to read, analyze and interpret business documents such as HMSA's Medical Policy Manual, plan certificates and Guide to Benefits, statistical data, product development memos and documents published by Blue Cross and Blue Shield Association related to compliance; the literature from Federal and/or state governments pertinent to the business (i.e. Federal Register, CMS guidelines, Hawaii Revised Statutes (H.R.S).
    • Ensures all appropriate processes are followed and documentation is completed as required by acting as quality control checkpoint verifying standards are adhered to.
  4. Proactively solve conflicts and address issues that could occur between HMSA, customers, and service providers.
  5. Maintain knowledge of current health plan related to claims and Association requirements.
  6. Perform all other miscellaneous responsibilities and duties as assigned or directed.

  • Claims Operation Specialist

    1 week ago

    Honolulu, United States HMSA Full time

    Collect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO). Compile reports about incidents, events, and updates...

  • Entry-Level Claims Specialist

    1 month ago

    Honolulu, Hawaii, United States ALTRES Staffing Full time

    Entry-Level Claims Specialist (Workers' Comp Work for a local insurance company, voted one of Hawaii's Best Places to WorkAs the Workers' Comp Claims Specialist, you will manage workers' compensation claims for medical only, lost time, and disfigurement. A current Hawaii worker's comp adjuster's license and basic understanding of workers' compensation laws,...

  • Entry-Level Claims Specialist

    1 month ago

    Honolulu, United States ALTRES Staffing Full time

    Entry-Level Claims Specialist (Workers' Comp) (203951-14)Work for a local insurance company, voted one of Hawaii’s Best Places to Work! As the Workers’ Comp Claims Specialist, you will manage workers’ compensation claims for medical only, lost time, and disfigurement. A current Hawaii worker’s comp adjuster’s license and basic understanding of...

  • Claims Examiner- P&C Insurance

    1 month ago

    Honolulu, United States cesna Full time

    Job DescriptionJob Description[Position]Claims Examiner[About Our Client]One of the largest non-life insurance companies based in South Korea. We currently writes all lines of property and casualty insurance in CA, NY, OH, IN, PA, TX and HI State.Financial Ratings:- A.M. Best Rating: A+ (Superior)“Superior: A++ to A+ grade assigned to insurance companies...

  • Accounts Receivable Specialist

    1 month ago

    Honolulu, Hawaii, United States realjobshawaii Full time

    Accounts Receivable Specialist (Medical Billing Are you a detail-oriented person and have previous accounts receivable experience? A local healthcare company is looking for someone to manage medical billing which includes processing denials for multiple clients/financial classes, running aging reports, handling periodic audits and ensuring all claims are...

  • Transportation Operations Specialist

    3 weeks ago

    Honolulu, Hawaii, United States General Services Administration Full time

    Summary This position is A Developmental Transportation Operations Specialist (Motor) using a basic foundation of transportation knowledge to independently perform routine administrative and analytical work of the organization.Location of position: General Services Administration (GSA), Federal Acquisition Service (FAS), Office of Fleet Management (QMD) in...

  • Accounts Receivable Specialist

    1 month ago

    Honolulu, United States ALTRES Staffing Full time

    Accounts Receivable Specialist (Medical Billing) (213995-14)Are you a detail-oriented person and have previous accounts receivable experience? A local healthcare company is looking for someone to manage medical billing which includes processing denials for multiple clients/financial classes, running aging reports, handling periodic audits and ensuring all...

  • Business Services Support Specialist

    1 week ago

    Honolulu, United States The Queen's Health Systems, Inc. Full time

    Under the general direction of the Business Services Manager, provides support services to the Medicare Certified Division staff. Performs a variety of duties including verification of health insurance claims numbers and benefits coverages; process a Support Specialist, Business Services, Support, Business, Specialist, Healthcare

  • hr specialist

    4 weeks ago

    Honolulu, Hawaii, United States Department Of The Air Force Full time

    Summary THIS IS A NATIONAL GUARD TITLE 5 EXCEPTED SERVICE POSITION.This National Guard position is for a HR SPECIALIST (TITLE 5), Position Description Number T5095000 and is part of the HI JFHQ AIR, National Guard. Duties SUMMARY OF DUTIES: The purpose of this position is to provide technical, procedural, and evaluative assistance in the area of employee...

  • Operations Specialist with Security Clearance

    3 weeks ago

    Honolulu, United States Cambridge International Systems, Inc. Full time

    When you join the Cambridge team, you are part of a skilled and talented global community that is united by a set of core values: commitment, integrity, and perseverance. Join our team and help us confront today’s most threatening and complex obstacles! Cambridge International Systems, Inc. has a full-time Operations Specialist opportunity available based...

  • Insurance Specialist II

    1 month ago

    Honolulu, United States Xtend Healthcare, LLC Full time

    Xtend Healthcare is a revenue cycle management company focused exclusively on the healthcare industry. The company's services range from full revenue cycle outsourcing, A/R legacy cleanup and extended business office to coding and consulting engagements. As part of Navient (Nasdaq: NAVI), Xtend taps the strength and scale of a large-scale business...

  • Insurance Specialist II

    1 month ago

    Honolulu, Hawaii, United States Xtend Healthcare, LLC Full time

    Xtend Healthcare is a revenue cycle management company focused exclusively on the healthcare industry. The company's services range from full revenue cycle outsourcing, A/R legacy cleanup and extended business office to coding and consulting engagements. As part of Navient (Nasdaq: NAVI), Xtend taps the strength and scale of a large-scale business processing...

  • Medical Billing Accounts Receivable Specialtist

    4 weeks ago

    Honolulu, United States ISLAND HEALTHCARE SOLUTIONS LLC Full time

    Job DescriptionJob DescriptionIsland Healthcare Solutions is a comprehensive billing, coding and consulting service focused on hospital-based physician and outpatient medical practice facilities.We are seeking to fill a full time accounts receivable specialist position.  This position requires attention to detail, ability to problem solve and work...

  • Membership Specialist

    2 days ago

    Honolulu, United States UFC Gym Full time

    Job DescriptionJob DescriptionThe Membership Specialist (MS) will represent UFC GYM by providing a welcoming, informative, and entertaining experience for all members and guests during their visits. The Membership Specialist is responsible for driving potential members into the gym to deliver industry leading customer services to them as well as our current...

  • Educational Specialist

    4 weeks ago

    Honolulu, Hawaii, United States realjobshawaii Full time

    Title: Educational Specialist (Simulation Technician)Position Number: THiring Unit: University of Hawaii at Manoa Nancy Atmospera-Walch School of NursingLocation: Honolulu/Manoa Campus/UH West Oahu Duties and Responsibilities:As a Simulation Lab Technician, develops technical knowledge of the operation and maintenance of the UH Translational Health Science...

  • it specialist

    1 month ago

    Honolulu, Hawaii, United States Department Of The Navy Full time

    Summary This is a public notice flyer to notify interested applicants of anticipated vacancies. Applications will not be accepted through this flyer. Interested applicants must follow the directions in the "How to Apply" section of this flyer to be considered. There may or may not be actual vacancies filled from this flyer. Notice of Result letters will not...

  • Medical Billing Accounts Receivable Specialtist

    4 weeks ago

    Honolulu, United States ISLAND HEALTHCARE SOLUTIONS LLC Full time

    Job DescriptionJob DescriptionBenefits:Competitive salaryDental insuranceFlexible scheduleHealth insurancePaid time offVision insurance Island Healthcare Solutions is a comprehensive billing, coding and consulting service focused on hospital-based physician and outpatient medical practice facilities.We are seeking to fill a full time accounts receivable...

  • Solutions Specialist

    1 month ago

    Honolulu, United States Old Dominion Freight Line Full time

    Additional Job DescriptionA Solutions Specialist will be required to obtain a maximum volume of profitable freight in his/her territory. The Solutions Specialist must provide responsive customer service and coordinate with operations to exceed their expectations. A Solutions Specialist will serve as the customer’s point of contact through in person...

  • PPBS Specialist

    4 weeks ago

    Honolulu, United States SAIC Full time

    Description We are seeking PPBS Specialists at all levels of experience (Junior thru Senior and SME) to support the United States Army Pacific Command (USARPAC) Task Order (TO). We are currently assembling our team of experienced professionals with a broad range of intelligence, operations, planning, data, training, and logistics solutions on an enterprise...

  • Unemployment Insurance Specialist

    1 week ago

    Honolulu, United States ‘ike Hawaii Full time

    When you choose DataHouse, you become part of an entrepreneurial culture that is passionate about making customers succeed through innovative technologies. As we grow our team and look to expand our customer base, we seek individuals with innovative ideas, deep subject matter expertise, a global perspective, and the kind of grit that allows you and your team...