Current jobs related to Medical Claim Specialist - Honolulu - HEMIC

  • Senior Claims Specialist

    6 days ago

    Honolulu, Hawaii, United States Zenith Full time

    Job SummaryZenith Insurance Company is seeking a highly skilled Senior Claims Specialist to join our team. As a key member of our claims department, you will be responsible for investigating, analyzing, and determining the extent of company liability concerning claims.Key ResponsibilitiesInvestigate and analyze claims to determine company liabilityCorrespond...

  • Property and Casualty Claims Specialist

    3 weeks ago

    Honolulu, Hawaii, United States cesna Full time

    Job OverviewPosition: Claims ExaminerAbout Our Company:Cesna is a prominent player in the non-life insurance sector, providing comprehensive coverage across various states. We specialize in all lines of property and casualty insurance, ensuring our clients receive exceptional service and support.Financial Strength:M Best Rating: A+ (Superior)S&P Rating: A...

  • Claims Specialist

    3 weeks ago

    Honolulu, United States Trustmark Full time

    Trustmark’s mission is to improve wellbeing – for everyone. It is a mission grounded in a belief in equality and born from our caring culture. It is a culture we can only realize by building trust. Trust established by ensuring associates feel respected, valued and heard. At Trustmark, you’ll work collaboratively to transform lives and help people,...

  • Workers Compensation Claims Adjuster

    3 weeks ago

    Honolulu, Hawaii, United States Gallagherbassett Full time

    **Job Summary**Gallagher Bassett is seeking a skilled Claims Adjuster - Workers Compensation Specialist to join our team. As a Claims Adjuster, you will be responsible for investigating, evaluating, and settling less complex claims with moderate supervision.**Key Responsibilities:**Investigate and evaluate claims to determine coverage, liability, and...

  • Claim Specialist WC

    4 months ago

    Honolulu, United States HEMIC Full time

    Job DescriptionJob DescriptionJoin us at HEMIC!Voted one of Hawai`i Business’ Best Places to Work for 5 Years in a Row!As a HEMIC employee, you will get:People Who CareVoted one of Hawai`i Business’ Best Places to Work, and Pacific Business News’ Best Workplaces, our business is founded on caring for Hawai`i workers, Hawai`i businesses, and each...

  • Claims Examiner

    3 weeks ago

    Honolulu, Hawaii, United States Gallagherbassett Full time

    **Job Summary**Gallagher Bassett is seeking a skilled Claims Adjuster - Workers Compensation Specialist to join our team. As a Claims Adjuster, you will be responsible for investigating, evaluating, and settling less complex claims with moderate supervision.**Key Responsibilities:**Investigate and evaluate claims to determine coverage, liability, and...

  • Commercial Property Claims Analyst

    4 weeks ago

    Honolulu, Hawaii, United States Zurich NA Full time

    Zurich North America is seeking a Commercial Property Claims Specialist. This role is designed for remote work, open to candidates located within the U.S.With moderate supervision, this position involves managing both single and multi-party claims related to personal or commercial lines that present low to moderate risk and complexity. The specialist will...

  • Claims Processor

    4 days ago

    Honolulu, Hawaii, United States Pacific Administrators Full time

    Job Title: Claims ProcessorWe are seeking a highly skilled Claims Processor to join our team at Pacific Administrators, Inc. As a Claims Processor, you will play a critical role in ensuring the smooth processing of medical, hospital, vision, chiropractor, and ancillary claims.Key Responsibilities:Coordinate benefit and third-party liability claims in...

  • Claims Processor

    3 weeks ago

    Honolulu, Hawaii, United States Pacific Administrators, Inc. Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Claims Processor to join our team at Pacific Administrators, Inc. As a Claims Processor, you will be responsible for processing medical, hospital, vision, chiropractor, and ancillary claims in accordance with our department policies and procedures.Key ResponsibilitiesProcess medical claims,...

  • Senior Claims Processor

    2 days ago

    Honolulu, Hawaii, United States University Health Alliance Full time

    Job Title: Senior Claims ProcessorJob Summary:We are seeking a highly skilled Senior Claims Processor to join our team at University Health Alliance. As a Senior Claims Processor, you will be responsible for processing and adjudicating medical claims in a timely and accurate manner.Key Responsibilities:Process and adjudicate medical claims, including...

  • Medical Claims Assistant

    1 month ago

    Downtown, Honolulu, United States ALTRES Staffing Full time

    Medical Claims Assistant (216345-14)We're immediately filling a full-time opening with one of Hawaii's best places to work! The selected candidate for this position will perform office and administrative support duties for the company's claims department. Qualified candidates will have at least one year of clerical/office work experience and be knowledgeable...

  • Commercial Property Claims Analyst

    4 weeks ago

    Honolulu, Hawaii, United States Zurich NA Full time

    Zurich North America is seeking a Commercial Property Claims Specialist for a remote position available to candidates across the U.S.In this role, you will manage personal and commercial line claims of low to moderate complexity and exposure, ensuring adherence to established protocols for efficient and customer-focused claims handling.Key...

  • Claims Adjuster Trainee

    3 weeks ago

    Honolulu, Hawaii, United States Pillfast24 Full time

    Job SummaryPillfast24 is seeking a highly motivated and detail-oriented Claims Adjuster Trainee to join our team. As a Claims Adjuster Trainee, you will learn the skills and knowledge necessary to help customers navigate the claims process and resolve disputes efficiently.Key ResponsibilitiesDetermine coverage and liability for claimsInterview customers,...

  • Claims Processor Associate

    1 week ago

    Honolulu, Hawaii, United States Adecco USA Full time

    Claims Processor Associate Job DescriptionWe are seeking a highly skilled Claims Processor Associate to join our team at Adecco USA. As a Claims Processor Associate, you will be responsible for processing claims documents, troubleshooting and resolving customer issues, and providing excellent customer service.Key Responsibilities:Process claims documents in...

  • Administrative Claims Assistant Workers Compensation Specialist

    14 hours ago

    Honolulu, Hawaii, United States GB - Global Full time

    About the RoleWe are seeking a highly organized and detail-oriented Administrative Claims Assistant to join our team at GB - Global. As a key member of our team, you will be responsible for providing administrative support to our claims team, ensuring the smooth operation of our claims process.Key ResponsibilitiesProvide administrative support to the claims...

  • Claim Assistant

    4 days ago

    Honolulu, Hawaii, United States HEMIC Full time

    Job Title: Claim AssistantWe are seeking a highly organized and detail-oriented Claim Assistant to join our team at HEMIC. As a key member of our Claims Department, you will play a vital role in supporting our injured workers and ensuring they receive the necessary care to return to work and life.Key Responsibilities:Manage critical daily deadlines and work...

  • Claims Management Trainee

    2 weeks ago

    Honolulu, Hawaii, United States Pillfast24 Full time

    Position Title: Claims Management TraineeCompany Overview: Join a recognized leader in the insurance industry.Role Overview: As a Claims Management Trainee, you will embark on a journey to assist clients in navigating the claims process following incidents. This role is primarily conducted over the phone, allowing you to cultivate relationships with clients...

  • Claims Processor I

    3 months ago

    Honolulu, United States Pacific Administrators, Inc. Full time

    Job DescriptionJob DescriptionDescriptionResponsible for the processing of all medical, hospital, vision, chiropractor, and ancillary claims, which includescoordination of benefit and third-party liability claims in accordance with department policies and procedures.Skills / Knowledge RequirementsType 45 WPM10 Key by TouchComputer literate in Word and Excel...

  • Claims Processor I

    4 months ago

    Honolulu, United States Pacific Administrators, Inc. Full time

    Job DescriptionJob DescriptionDescriptionResponsible for the processing of all medical, hospital, vision, chiropractor, and ancillary claims, which includescoordination of benefit and third-party liability claims in accordance with department policies and procedures.Skills / Knowledge RequirementsType 45 WPM10 Key by TouchComputer literate in Word and Excel...

  • Claims Adjuster Workers Compensation

    4 weeks ago

    Honolulu, United States Arthur J. Gallagher & Co. Full time

    ** Claims Adjuster Workers Compensation** **** New * Investigates, evaluates, disposes and settles less complex claims with moderate supervision and includes the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves. * Incumbents at this level typically hold claims reserve and settlement authority...

Medical Claim Specialist

4 months ago

Honolulu, United States HEMIC Full time
Job DescriptionJob Description

Join us at HEMIC

Voted one of Hawai`i Business’ Best Places to Work for 6 Years in a Row

As a HEMIC employee, you will get:

  • People Who Care

Voted one of Hawai`i Business’ Best Places to Work, and Pacific Business News’ Best Workplaces, our business is founded on caring for Hawai`i workers, Hawai`i businesses, and each other.

  • Professional Growth

We’re passionate about your development. Whether it’s achieving a formal certification or attending a workshop to improve your communication skills, we will support and encourage you to grow.

  • Benefits & Perks

We offer competitive salary and best-in-class benefits, including a 401k match, flex-time, generous PTO, 15 paid holidays, and so much more

  • Opportunity to Give Back

Giving back to our community is our kuleana and we offer numerous opportunities for our employees to take part - whether it be volunteering for a fundraiser, attending a charity walk, or getting a match for your charitable contributions.

Why our Medical Claim Specialist is Important:

A company buys insurance for financial security. When an injury or loss occurs, the claimant expects to receive treatment and compensation in a timely manner. Delivery on this is the heart of the claims function and process. Our Medical Claim Specialist carries out our promise of "Proudly Taking Care of Hawai`i" by working with injured workers to get the necessary care so that they can get back to work and life. Training will be provided.

Essential Duties

  • Manage medical only, lost time, and disfigurement claims. The assignment is based on the assessment and determination of the Manager. Training will be provided.
  • Review First report (WC- 1) for accuracy and completion.
  • Complete 24-hour three-point contact with Claimant, Employer, and Physician. Secure formal statements from injured workers as deemed appropriate.
  • Calculate average weekly wages and compensation rate. Issue timely indemnity benefits in compliance with H.R.S. 386.
  • Identify any potential third party (subrogation).
  • Process medical bills in compliance with Hawaii State Medical Fee Schedule and Claim Best Practices.
  • Develop and collaborate to implement claim strategies to facilitate case resolution.
  • Document and work within all Claim-related systems including but not limited to Guidewire, Image Right, My Matrix (Express Scripts), and IQ Review (AMC Bills).
  • Complete reinsurance reporting of financial exposures meeting the criteria ($250,000.00 and/or catastrophic).
  • Establish reserves based upon Probable Ultimate Cost.
  • Attend hearings before the Director as deemed appropriate by Claim Management and claim reviews on dedicated accounts as needed.
  • Maintain current diary.
  • Other duties as assigned.

Requirements

  • Basic understanding of workers’ compensation laws, rules, and regulations (preferred).
  • Current Hawaii Workers’ Comp Adjusters License (preferred).
  • Familiarity with medical and legal terminology (preferred).
  • Willingness to learn and develop professionally.
  • Excellent customer service skills, accuracy, attention to detail, and communication (written and verbal).
  • Ability to maintain confidential information.
  • Able to work independently as well as collectively as a team.
  • Proficiency with Microsoft Office Suite.
  • Self-directed and flexible.

Position title

Medical Claim Specialist

Department

Claim

Work Arrangement

In-Person, HEMIC Tower

Reports To

Manager, Claim

Direct Reports

N/A

FLSA Status

☒ Exempt ☐ Non-Exempt Job Class: 2-Prof

Approved By:

clewis

Date Approved:

4/23/2024

Reviewed:

N/A

NOTE: The above information on this job description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory, or all duties, responsibilities, and qualification of employees assigned to this job. Management has the right to add, revise or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential duties of this position.