Claims Operation Specialist

3 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 month ago

    Honolulu, United States Hawaii Medical Service Association Full time

    Note: Individuals typically begin between the minimum to middle of the pay range The Claims Operation Specialist tracks, analyzes, and resolves claims and claims related system issues while collaborating with our vendor to streamline operational processes. In this role, the Specialist will monitor vendor adherence to Service Level agreements, tracking issues...

  • Entry-Level Claims Specialist

    2 months 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,...

  • Workers Compensation Claims Team Lead | Honolulu, HI

    6 days ago

    Honolulu, United States Sedgwick Claims Management Services Full time

    Global Privacy Policy Sedgwick’s caring counts® commitment is to value the right of privacy of the companies and individuals we serve. It is Sedgwick’s policy to comply with all applicable privacy and data protection laws and maintain the trust of those we serve. We want to share with you our policy to what personal information we may collect, how we...

  • Medical Claim Specialist

    3 days ago

    Honolulu, United States HEMIC Full time

    Job DescriptionJob DescriptionJoin 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 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...

  • 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 Specialist

    3 days ago

    Honolulu, United States ResCare Full time

    Our Company PharMerica Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking...

  • Claim Specialist WC

    3 days 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 Adjuster Workers Compensation

    5 days 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...

  • Claims Processor I

    1 month 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 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...

  • Operations Specialist

    5 days ago

    Honolulu, United States Conservationconnections Full time

    Become part of Hawaii’s conservation story Reports to: VP of Operations Type: Full Time, Non-Exempt Kupu, which means “to sprout” or “to grow” in Hawaiian, has a two-fold mission: to preserve the land while empowering youth. The organization provides hands-on training in conservation, sustainability, and environmental education for young adults,...

  • HR Operations Specialist

    1 week ago

    Honolulu, United States American Savings Bank Full time

    Administers the day-to-day operations of benefit and HR programs. Provides direction/guidance to teammates on HR processes and queries. Major Job Accountabilities. Retains high-level, comprehensive knowledge of Human Resources functions. Answers team Operations Specialist, Operations, Specialist, HRIS, HR, Manufacturing, Banking

  • Accounts Receivable Specialist

    2 months 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...

  • Operations Specialist

    4 days ago

    Honolulu, Hawaii, United States realjobshawaii Full time

    Location: Honolulu, HI (677 Ala Moana Blvd)Reports to: VP of OperationsType: Full Time, Non-ExemptKupu's StoryKupu, which means "to sprout" or "to grow" in Hawaiian, has a two-fold mission: to preserve the land while empowering youth. The organization provides hands-on training in conservation, sustainability, and environmental education for young adults,...

  • Operations Specialist

    3 days ago

    Honolulu, United States realjobshawaii Full time

    Location: Honolulu, HI (677 Ala Moana Blvd) Reports to: VP of Operations Type: Full Time, Non-Exempt Kupu’s Story Kupu, which means “to sprout” or “to grow” in Hawaiian, has a two-fold mission: to preserve the land while empowering youth. The organization provides hands-on training in conservation, sustainability, and environmental education...

  • Transportation Operations Specialist

    1 month 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...

  • Branch Support Specialist

    1 week ago

    Honolulu, United States Allied Universal Full time

    Job Description Hiring a Branch Support Specialist in Oahu for Allied Universal! Pay Rate $25hr Allied Universal® is hiring a Branch Support Specialist. The Branch Support Specialist is responsible for being the primary contact for branch management for all general benefit issues, resolution of payroll discrepancies, compliance reporting,...

  • Operations Specialist

    3 days ago

    Honolulu, United States H&R Block Full time

    H&R Block Operations Specialist - S Honolulu , Hawaii Apply Now The Operations Specialists - Seasonal is responsible for non-systems duties such as delivering supplies/materials to offices, basic maintenance repairs and assisting with annual set up/closing of offices. Duties and Responsibilities: Perform basic building maintenance such as replacing light...

  • Operations Specialist

    2 days ago

    Honolulu, United States Booz Allen Hamilton Full time

    Operations Specialist The Opportunity: As an expert in defense missions, your unique background inspires you to think bigger, push further, and ask questions others don't. We need your extensive industry knowledge and advisory skills to solve some of our client's most complex problems-and find solutions that keep our nation safe. As an Operations Specialist,...