Manager, Claims
2 weeks ago
- Manage and lead a claims team by providing training, mentorship, and best practice solutions.
- Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims
- Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA.
- Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction
- Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely claims processing.
- Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
- Contribute to the development and implementation of new policies, procedures, and systems to improve claims operations.
- Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
- Three years of experience in management, preferably within health insurance; or equivalent combination of leadership experience or experience leading teams.
- In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans
- Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge)
- Effective written and verbal communication skills
- Intermediate working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.
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Manager, Claims
4 days ago
Honolulu, HI, United States HMSA Full timeManage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs)...
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Manager, Claims
2 weeks ago
Honolulu, HI, United States HMSA Full timeManage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs)...
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Manager, Claims
7 days ago
Honolulu, HI, United States HMSA Full timeManage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs)...
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Claims Specialist
2 weeks ago
Honolulu, HI, United States Island Holdings Full timeSummary: Under minimal to no supervision, reviews, investigates, evaluates, negotiates and resolves a variety of multi-line casualty claims including but not limited to disputed liability, personal injury, coverage disputes, and contract based losses, and specialty claims of a complex nature. Independently handles all aspects of assigned claim inventory in...
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Director, Claims Operations
1 week ago
Honolulu, HI, United States Hawaii Medical Service Association Full timeDesign and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are...
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Director, Claims Operations
2 weeks ago
Honolulu, HI, United States Hawaii Medical Service Association Full timeDesign and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are...
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Director, Claims Operations
2 weeks ago
Honolulu, HI, United States Hawaii Medical Service Association Full timeDesign and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are...
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Director, Claims Operations
1 week ago
Honolulu, HI, United States Hawaii Medical Service Association Full timeDesign and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are...
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Construction Engineer
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Honolulu, HI, United States Honolulu Authority for Rapid Transportation Full timeJoin Us! The Honolulu Authority for Rapid Transportation (HART) is the public transit authority responsible for planning and constructing Skyline, Honolulu's rail transit system. It is the first fully automated, driverless urban light metro system in the United States and represents the largest public infrastructure project in the history of Hawaii. ...
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Construction Engineer
1 week ago
Honolulu, HI, United States Honolulu Authority for Rapid Transportation Full timeJoin Us! The Honolulu Authority for Rapid Transportation (HART) is the public transit authority responsible for planning and constructing Skyline, Honolulu's rail transit system. It is the first fully automated, driverless urban light metro system in the United States and represents the largest public infrastructure project in the history of Hawaii. ...
