Case Management, Claims Management, Claims Processing, Compensation and Benefits, Cross-Functional, Problem Solving Skills, Process Improvement, Regulations, Service Level Agreement (SLA), Systems Maintenance, Time Management, Training/Teaching
- Function as a central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions.
- Investigate and resolve escalated claims and trends, including denied or delayed claims, by coordinating with relevant departments to implement short- and long-term solutions and process improvements.
- Manage open claims issues to ensure timely resolution in compliance with internal SLAs and regulatory standards.
Collaborate with internal teams to conduct training sessions and measure effectiveness of training.
- Provide support for audits, appeals, and compliance-related activities
- Participate in system updates, and cross-functional meetings to stay current on claims processing procedures and benefit plan designs.
- Document all interactions, updates, and outcomes clearly in case management or claims systems.
- Performs all other miscellaneous responsibilities and duties as assigned or directed
#LI-Hybrid
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Hawaii Medical Service Association