Job Description: Analyzes, researches, and interprets medical and claims data while processing authorization.... Refers requests to Medical Directors for determination when appropriate following department and regulatory guidelines...
, ensuring timely resolution and maintaining a high level of service and meeting SLA response times. Manage inventory of agency... of Hawaii Department of Commerce and Consumer Affairs or pass all four sections of the state licensing examination within three...
to compliance guidelines including but not limited to HIPAA Core Rules, Washington Publishing Company Updates, BCBS Association... work effort for Disbursements functions such as recovery of provider negative balance, review and reconciliation of medical...
metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement... performance reporting. Capture potential value leakage and/or service level penalties. Coordinate implementation of SLA...
department and external service providers to enhance claims platforms and integrate automation, AI, and data analytics tools... responsibilities and duties as assigned or directed. Support relationship(s) with service providers as applicable. #LI-Hybrid...
, endpoint protection, etc.). Strong customer service skills. Strong process and project management skills. Intermediate...
Job Description: a. Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and co...
Job Description: Monitor the performance and address issues with any business partners or vendors that supports the Members Servicing Department. Build relationships with both internal and external customers to include members and emplo...
Job Description: Business Systems and Reporting Generates reports and, as appropriate, coordinates the regular creation, production, and maintenance of department reports. When appropriate, build needed reports and extract from system. ...
Job Description: Responsible for managing all aspects of the planning, execution, controlling, and closure of projects/programs. Responsibilities include, but are not limited to, the following: Receives high-level business requirements a...
Job Description: Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and colla...
Job Description: Stakeholder Support: Support product managers by eliciting stakeholder input, documenting product needs, and participating in discussions across the product lifecycle. Assist with stakeholder communications to clarify g...
Job Description: Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, ...
Job Description: Data Analysis and Reporting Conduct high quality, objective analysis to support performance optimization and strategic initiatives. Collect, interpret, and evaluate Key Performance Indicators (KPIs) and related info...
Job Description: Product Ownership & Agile Delivery: Develop, maintain and communicate product vision & roadmaps, ensuring alignment with organizational goals, technology trends, and customer needs. Represent the voice of the custom...
Job Description: Lead as an IO Audit and Control Subject Matter Expert (SME) on process and controls. Review and monitor design of IO controls department-wide with the purpose of identifying ineffective or inefficient processes and advis...
Job Description: Oversee and manage accounting operations for HMSA and its subsidiaries, including general ledger and reconciliation activities. Streamline processes and implement efficiencies to optimize financial operations. Ensure ac...
Job Description: 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 esc...
Job Description: Reviews and conducts analysis of financial statements for HMSA and other related entities in an accurate and timely manner. This includes preparation, summarization, and maintenance of source data in various subsystems o...
Job Description: Coordinates various projects as assigned. Develops system requirements, test plan, test scenarios, test cases, anticipated test results and objectives and acceptance criteria. Also, performs testing, communicates status/...