Hawaii Medical Service Association
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.
#LI-Hybrid
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.
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.