29 Results for

Claims Specialist Jobs in Honolulu, HI

Jobs

Honolulu, HI30+ days ago

$72,516–$103,212

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. Reporting directly to the Construction Claims Manager, the Construction Engineer will play a key role in managing construction claims, ensuring compliance with contracts, and supporting litigation efforts.

Honolulu, HI30+ days ago

Remote

$223,800–$313,100 Per Year

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.

Honolulu, Hawaii19 days ago

$22–$26 Per Hour

New!

Honolulu, HI4 days ago

$60,000–$90,000 Per Year

The Claims Examiner will oversee claim investigations, evaluate coverage and damages, coordinate with Third-Party Administrators (TPAs), field adjusters, consultants, and vendors, and negotiate claim settlements in accordance with company guidelines and regulatory requirements. This role is responsible for managing complex Property and Casualty insurance claims including structural property damage, auto liability, casualty, and workers’ compensation-related claims.

kAPOLEI, HI8 days ago

$70,000–$95,000

This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff. At the direction of the Claims Supervisor and/or Claims Manager, the Claims Adjuster/Examiner II / III manages all aspects of workers’ compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.

Honolulu, HI30+ days ago

Remote

Full-time

Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete.

New!

Kapolei, HI1 day ago

$85,000–$90,000

This role handles highly complex claims and plays a critical part in ensuring compliance with state regulations, timely investigations, accurate reserving, and effective claim resolution. The position requires strong analytical judgment, excellent communication skills, and consistent collaboration with clients, claimants, vendors, legal counsel, and internal teams.

Honolulu, HI27 days ago

Full-time

The ideal candidate will excel at collaborating with third-party adjusters, vendors, and industry experts to ensure claims are handled efficiently and accurately while delivering exceptional service to agents and claimants. This role involves overseeing and managing complex property and casualty claims, including those related to building and structural damage, auto, and workers’ compensation.

New!

Honolulu, HI1 day ago

$85,000–$90,000

Reporting to Claims Leadership, this role is responsible for end-to-end claim ownership—from intake and investigation through resolution—while operating within established authority levels and client guidelines. A leading Third Party Administrator is seeking an experienced Workers’ Compensation Claims Adjuster to manage a diverse caseload of Hawaii workers’ compensation claims.

Honolulu, HI26 days ago

Remote

Full-time

Technical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.

Honolulu, HI26 days ago

Full-time

The incumbent will also work closely with MTF staff to support TRICARE beneficiaries and provide non-clinical support for patient referrals and authorizations; outreach to network providers as necessary; and to facilitate the support of applicable TriWest departments for resolving network gaps, provider and contract concerns, customer service requests, and discharge coordination for patients from network and non-network facilities. • Performs on-site and virtual outreach activities for military installation community and beneficiary groups such as Family Readiness Groups, Retiree Associations, and Installation New-comers Orientation, and provides educational briefings on such matters as transferring TRICARE enrollment, PCM selection, and other interest areas for new people to the community.

Honolulu, HI26 days ago

Remote

Full-time

Technical Skills: Proficient with key databases, including FoxPro, Claims Systems, Medical Management Systems, and Provider Data Management Systems; working knowledge of VA policies and procedures, current knowledge of claims, reimbursement methodology; healthcare or managed care experience. • Communicate clearly through both written and verbal forms of communication and follow up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately.

Honolulu, Hawaii30+ days ago

$24.10–$30.66 Per Hour

From Australia to California, and of course, Hawaii, Team Servco is a collective of over 2,000 like-minded individuals guided by our four Core Values of Respect, Service, Teamwork, and Innovation. This role supports dealers with claims procedures and serves as a liaison between dealers and our manufacturers to ensure accurate, timely submission of required documentation and evidence.

Honolulu, HI30+ days ago

Remote

$113,000–$120,000 Per Year

Product Specialist , you will make an impact by configuring and maintaining QNXT systems to support provider contracts, benefits, and fee schedules. Regardless of your working arrangement, we are here to support a healthy work-life balance through our various wellbeing programs.

Honolulu, Hawaii7 days ago

Join Allied Universal as an unarmed driving patrol officer at a commercial real estate location, where you will conduct routine patrols, stay visible to help deter security-related incidents, and deliver outstanding customer service. Provide customer service to tenants, visitors, and/or property staff by carrying out security-related procedures, site-specific policies, and when appropriate, emergency response activities at a commercial real estate location.

Honolulu, HI25 days ago

Full-time

Issues and strictly controls Armed Forces identification and privilege cards for all eligible personnel, (i.e., active duty military, retired military, 100% Disabled American Veteran (DAV) and respective dependents and verified contractors. Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations designated as Defense Enrollment Eligibility Reporting System (DEERS) and Real-time Automated Personnel Identification System (RAPIDS) sites.

Honolulu, Hawaii15 days ago

Join Allied Universal as a Patrol Officer in a premier retail location, where you will monitor and patrol assigned areas, maintain a visible presence to help deter security-related incidents, and deliver exceptional customer service. Support loss prevention awareness by maintaining a visible presence, following post orders, and assisting with security-related response procedures related to disturbances, alarms, and/or emergency situations.

HONOLULU, HI30+ days ago

Completes On-Shelf Availability (OSA) end-to-end process including warehouse and direct store delivery (DSD) for planogrammed departments, executing disposals, call-ins, and vendor returns before expiration, completes scan outs/ scan outs returns on all subscribed departments including vendor/ DSD departments and pharmacy scan outs. + In designated stores, when serving as the leader on duty, responsible and accountable for registering all related sales on assigned point-of-sale system (POS), including records of scanning errors, price verifications, items not on file, price modifications, and voids.

Honolulu, Hawaii7 days ago

Join Allied Universal as an unarmed patrol officer at a dynamic aero and defense location, where you will conduct routine patrols, maintain a visible presence to help reduce security-related concerns, and deliver outstanding customer service and communication. Complete required reports and documentation related to patrols, incidents, and/or observations, and report maintenance concerns, hazards, and/or security-related issues to the appropriate personnel.

Kailua, HI30+ days ago

In addition, during employment individuals may be required by CDM Smith or a CDM Smith client to successfully complete additional background checks, including motor vehicle record as well as drug testing. • Expert Testimony and Litigation Support: In cases of disputes or litigation, Specialist may be required to present their findings in court, provide expert testimony, and assist attorneys in building their cases.

Honolulu, HI30+ days ago

Remote

$223,800–$313,100 Per Year

Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.

Honolulu, HI30+ days ago

Remote

$246,100–$344,200 Per Year

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Honolulu, HI30+ days ago

Remote

$223,800–$313,100 Per Year

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.

Honolulu, HI30+ days ago

Remote

$223,800–$313,100 Per Year

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. The Medical Director’s work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.

Honolulu, HI30+ days ago

Full-time

Voluntary benefits include additional term life insurance, long term care insurance, critical illness and accidental injury insurance, pet insurance, legal plan, identity theft protection, and other voluntary benefit options. • Set up and implement job procedures and techniques to assure timely buyout, shop drawing approval and material delivery.

Honolulu, HI30+ days ago

Leveraging your profound expertise in graph databases (e.g., Neo4j, ArangoDB, Amazon Neptune, Ontotext GraphDB), distributed graph processing frameworks (e.g., Apache Spark GraphX, Dask-Graph), and leading GML libraries (e.g., PyTorch Geometric, DGL, Spektral), you will conduct in-depth research, construct sophisticated predictive, prescriptive, and diagnostic models directly on graph structures. You will proactively identify opportunities to construct and leverage comprehensive healthcare knowledge graphs, integrating diverse patient, provider, claims, and clinical data to uncover hidden patterns, propagate insights through networks, and develop groundbreaking analytical solutions that exploit the rich, multi-modal structures within healthcare.

Honolulu, HI21 days ago

Prepares customer statements, bills and invoices, reconciles expenses to the general ledger, takes care of basic client inquiries, and performs other clerical tasks related to maintaining the accounts receivable records for the organization. Ensures regular payor (provider representatives) meetings are conducted to ensure trends are addressed and individual accounts are resolved.

Honolulu, HI27 days ago

Remote

Berry Street empowers independent dietitians to accept insurance and grow thriving private practices by providing comprehensive credentialing, scheduling, referral, and technical support, as well as access to a vibrant, collaborative clinician community. Dietitians working with Berry Street are committed to these pillars of high-quality care: Evidence-based: We provide quality care based on the latest clinical research.

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Claims Specialist Jobs in Honolulu, HI

Jobs

Construction Engineer (Construction Claims Specialist)Honolulu Authority for Rapid Transportation

Medical Director - Claims ManagementHumana

Surveillance / Claims Investigator - Part-TimeAllied Universal

Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HIAllSearch Professional Staffing

Workers Compensation Claims Examiner II/III - HybridTEEMA

Sr Claims ReviewerTriWest Healthcare Alliance

Workers Compensation Claims Examiner II/IIITEEMA Group

Claims Examiner - HYBRIDDB Insurance Co., Ltd.

Claims Supervisor - Workers CompensationCala Sourcing Solutions LLC

Program Integrity Clinical Specialist (RN or PA Req'd)TriWest Healthcare Alliance

Field Support SpecialistTriWest Healthcare Alliance

Provider Data SpecialistTriWest Healthcare Alliance

Warranty SpecialistServco Pacific Job Distro

Sr. QNXT Configuration SpecialistCognizant

Security Officer Driver Patrol SpecialistAllied Universal

ID Card Specialist; Honolulu, HIMagellan Health Services, Inc.

Security Officer Retail Patrol SpecialistAllied Universal

Inventory SpecialistWalgreens

Security Officer PT Foot Patrol SpecialistAllied Universal

FEMA Disaster Management AccountantCDM Smith

Medical Director - Northeast RegionHumana

Medical Director - Medicare Grievances and Appeals CorporateHumana

Medical Director - Southeast RegionHumana

Medical Director - FloridaHumana

Senior Project ManagerSwinerton Builders

Lead Data Scientist - Research and Development - Graph IntelligenceHighmark Health

Revenue Cycle CoordinatorSurgicare of Hawaii, Inc.

Remote Registered Dietitian or CNS - Flexible Hours, Work from AnywhereBerry Street

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