Current jobs related to Case Resolution Specialist II - Honolulu - HMSA
-
Customer Service Specialist II
3 weeks ago
Honolulu, United States Savers | Value Village Full timeSavers | Value Village Customer Service Specialist II Honolulu, Hawaii Apply Now Applicants need to be located on the island of Oahu Summary: Supports Savers mission and vision by providing exceptional customer service responding to inquiries from internal and external customers. This position will serve as the initial point of contact for donor escalated...
-
Benefits Specialist II
2 weeks ago
Honolulu, United States Amentum Full timeAmentum Benefits Specialist II Honolulu, Hawaii Apply Now The Benefits Specialist II will support the Benefits Manager by providing administrative support in implementing company-wide health and welfare benefit programs and policies. This position is a remote-telework role. US Citizenship is required. Assist in the administration, monitoring and day-to-day...
-
Instructional Support Specialist I, II, III
1 week ago
Honolulu, Hawaii, United States Hawaii State Department of Education Full timePosition Overview:This announcement is intended to recruit for various Instructional Support Specialist roles within the designated area. The highest level of these roles is Instructional Support Specialist III, with applications being accepted for lower levels (I and II) in case of recruitment challenges.Compensation:Instructional Support Specialist I,...
-
Customer Service Representative II
16 hours ago
Honolulu, Hawaii, United States Savers | Value Village Full timeJob SummarySavers | Value Village is seeking a highly skilled Customer Service Specialist II to join our team. As a key member of our customer service team, you will be responsible for providing exceptional support to our customers, resolving issues, and ensuring a positive experience.Key ResponsibilitiesCustomer Service: Respond to customer inquiries,...
-
Node Site Operations Specialist
3 days ago
Honolulu, Hawaii, United States General Dynamics Information Technology Full timeNode Site Operations Specialist / Senior Systems Administrator – TS/SCI required Transform technology into opportunity as a Node Site Operations Specialist / Senior Systems Administrator with General Dynamics Information Technology. A career in enterprise IT means connecting and enhancing the systems that matter most. At GDIT, you'll be at the...
-
Node Site Operations Specialist
1 week ago
Honolulu, Hawaii, United States General Dynamics Information Technology Full timeNode Site Operations Specialist / Senior Systems Administrator – TS/SCI required Transform technology into opportunity as a Node Site Operations Specialist / Senior Systems Administrator with General Dynamics Information Technology. A career in enterprise IT means connecting and enhancing the systems that matter most. At GDIT, you'll be at the...
-
Customer Service Specialist II
3 months ago
Honolulu, United States Savers | Value Village Full timeDescription Pay Range: $16.20 - $21.38 per hour Applicants need to be located on the island of Oahu Job Title: Customer Service Specialist IIWho we are: As one of the largest for-profit thrift operators in the United States, Canada and Australia for value priced pre-owned clothing, accessories and household goods, our mission is to champion reuse and...
-
SIGINT Policy Resolution Specialist
1 week ago
Honolulu, Hawaii, United States Allen Integrated Solutions Full timePosition OverviewTitle: Security - Dissemination Policy Resolution (SIGINT) Opening #504Required Security Clearance: TS/SCI + Subject to Counterintelligence (CI) polygraphLocation: HawaiiKey Responsibilities:Analyze multi-discipline intelligence to produce integrated assessments, indications & warnings, and comprehensive threat evaluations.Engage with NSA's...
-
Customer Care Specialist
2 months ago
Honolulu, United States Toshiba Business Full timeCustomer Care Specialist II Customer Care Support Specialist II Toshiba America Business Solutions is a leader in digital technology. Our people bring creative, real-world solutions for our client's print management needs; we help cut costs, secure documents, and reduce the environmental footprint. We are a growing, dynamic organization that offers job...
-
Customer Support Representative II
1 week ago
Honolulu, Hawaii, United States Savers | Value Village Full timePosition Overview:As a Customer Service Specialist II at Savers | Value Village, you will play a crucial role in delivering outstanding customer support while upholding the company’s mission and vision. This role is essential in addressing inquiries from both internal and external customers.Key Responsibilities:1. Manage escalated donor concerns and...
-
Culinary Specialist II
4 days ago
Honolulu, Hawaii, United States Highgate Full timeJob Title: Culinary Specialist II - Part-TimeCompany: Highgate HotelsOverview:Join the esteemed team at Highgate Hotels, a prominent player in real estate investment and hospitality management. Renowned for our innovative strategies, we have established a significant footprint in major U.S. markets and are expanding internationally. Our diverse portfolio,...
-
Culinary Specialist II
1 week ago
Honolulu, Hawaii, United States Highgate Full timeJob Title: Culinary Specialist II - Part-TimeCompany: Highgate HotelsOverview:Join the esteemed team at Highgate Hotels, a prominent player in real estate investment and hospitality management recognized for its forward-thinking strategies within the sector. With a robust footprint in key U.S. cities such as New York, Boston, and Miami, alongside growth...
-
Culinary Specialist II
1 week ago
Honolulu, Hawaii, United States Highgate Full timeJob Title: Culinary Specialist II - Part-TimeCompany: Highgate HotelsOverview:Join the dynamic team at Highgate Hotels, a premier real estate investment and hospitality management firm recognized for its forward-thinking strategies in the sector. With a robust footprint in key U.S. cities such as New York, Boston, and Miami, alongside growth into Europe,...
-
Culinary Specialist II
4 days ago
Honolulu, Hawaii, United States Highgate Full timeJob Title: Culinary Specialist II - Part-TimeCompany: Highgate HotelsPosition Overview:Join the esteemed team at Highgate Hotels, a prominent player in real estate investment and hospitality management, recognized for its forward-thinking strategies within the sector. With a robust footprint in key U.S. cities such as New York, Boston, and Miami, and an...
-
Behavioral Health Case Manager II
3 months ago
Honolulu, United States Hawaii Health & Harm Reduction Center Full timeJob DescriptionJob DescriptionHawai’i Health & Harm Reduction Center (HHHRC) provides harm reduction-focused services to marginalized populations in Hawai’i, including people living with and/or affected by HIV, hepatitis, substance use, homelessness, and the transgender, LGBQ, and the Native Hawaiian communities. HHHRC bridges gaps and helps individuals...
-
Case Manager, RN
2 months ago
Honolulu, United States Hawaii Pacific Health Full timeJob Description Founded in 1921, Straub Medical Center includes a 159-bed hospital in Honolulu, a network of neighborhood clinics and a visiting specialist program that reaches throughout the state of Hawai'i. With over 200 physicians who are leaders in their fields, Straub provides its patients with diagnoses and treatments for more than 32 different...
-
CAD Specialist II
3 weeks ago
Honolulu, United States AECOM Full timeJob DescriptionAECOM Honolulu is currently seeking a CAD Specialist II to support our civil infrastructure team. This role is located on a client jobsite and is not a telecommute/remote position. This person will be responsible for but not limited to the following:Performs CADD assignments and coordinates CADD drawing production in support of the CADD or...
-
Customer Service Specialist II
3 weeks ago
Honolulu, United States Savers | Value Village Full timeDescription Applicants need to be located on the island of Oahu Summary: Supports Savers mission and vision by providing exceptional customer service responding to inquiries from internal and external customers. This position will serve as the initial point of contact for donor escalated calls, emails and internal customer calls during normal hours of...
-
Sr. Case Manager
3 months ago
Honolulu, United States BI Incorporated Full timeJob Description Benefits Information Benefits As a Senior Case Manager, you will be part of a stable, established, and yet still growing organization with a great deal of diversification, which will present you with a range of different challenges. Since we do prefer to promote from within, you will have opportunities to move to other facilities as well as...
-
facility access specialist ii
3 months ago
Honolulu, Hawaii, United States realjobshawaii Full timeDisability and Communication Access BoardDowntown, Oahu FACILITY ACCESS SPECIALIST IISalary commensurate w/ training and experience Exempt, non-civil service, full-time, permanent appointment. The primary purpose of this position is to conduct complex reviews of documents under HRS § 103-50, provide technical assistance relating to architectural and...
![HMSA](https://media.trabajo.org/img/noimg.jpg)
Case Resolution Specialist II
2 months ago
- Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements.
- Secures information from internal and external resources to resolve issues.
- Functions as a liaison with providers, members and internal decision makers in representing HMSA objectives, goals, and expectations for meeting contractual, regulatory, and accreditation requirements.
- Negotiates/resolves sensitive issues with internal and external parties.
- Negotiates fees on behalf of members for non-covered or nonparticipating provider services in addition to soliciting claims and other related medical information from providers in order to resolve member inquiries.
- Takes all facts and research from internal and external resources and presents a full explanation of the member's or provider's position and concerns to management and decision makers.
- Triages cases to resolve them upon initial inquiry to best service the member as well as minimize the number of cases escalated to senior management and executives.
- Participates on cross departmental committees and other internal meetings to identify, clarify, research, and resolve inquiries and issues.
- Identifies when changes to policies and procedures are needed based on case resolutions, statutory or regulatory changes, or accreditation requirements.
- Proposes changes to management based on identification and analysis.
- Analyzes and identifies issues that may require multiple department efforts to resolve.
- Coordinates discussions and meetings to develop processes to resolve those issues.
- Presents recommendations to internal committees, subgroups and executive management for decision making purposes as it relates to cases.
- Assists with the implementation of resulting decisions for change/resolution.
- Assists supervisor/manager in responding to internal investigations, reviews, and audits; regulatory inquiries; and accreditation related audits.
- Assist internal customers with complex member/physician inquiries.
- Assists Supervisor and Coordinator with training.
- Identifies member problems, member education needs, or trends and report these to manager, as well as recommend resolution. Takes a proactive role in reviewing, digesting and communicating any new regulation, standard, business change, etc. affecting the member advocacy and/or appeals process. Assists in the coordination of changes among departments. Assists in determining internal and external impacts.
- Performs quality assurance of case documents and assists Supervisor and Manager with various corporate activities.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid