HMSA Jobs in United States

+Hybrid Work Environment - Must reside on Oahu+Responsible for performance governance across multiple provider contracts, analysis of network performance, and ensuring regulatory network requirements are measured and reported. · Minimum Qualifications · Bachelor's degree and five ...

This role optimizes encounter data submissions, collaborating with other departments to maximize quantity and quality of encounter information. · ...

The Nurse Reviewer will utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. · Responsibilities include:Evaluate suspended claims agains ...

This position plays a pivotal role in driving innovation, efficiency, and successful solution design within our healthcare IT projects, · Collaborate with cross-functional teams to understand business needs and translate them into innovative and scalable solution designs that add ...

The Claims Liaison Coordinator functions as the critical link between internal and external partners and is responsible for researching, analyzing and resolving high priority, complex claim issues · The coordinator also supports process improvement initiatives by identifying tren ...

Job Description · The Lead Associate will provide a differentiated experience for customers by offering high-touch service, sales, and support while promoting HMSA's brand. · Manage customer traffic levels to ensure efficient staffing and operation. · Handle customer escalations ...

Hybrid Work Environment - Must reside in Hawaii Individuals typically begin between the minimum to middle of the pay range Focused on HMSA's Government Programs plans (Medicare Medicaid ACA) extracts data from multiple internal and external sources provides statistical financial ...

Job Description · The Health Plan Navigator guides members through HMSA's health plan benefits and programs. · Assist customers by phone, in-person, virtual, and online servicing tools. · Maintain relationships with customers to improve consumer experience and health outcomes. · ...

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 customer and business stakeholders within the Scrum team, ensuring use ...

A healthcare services provider is seeking a full-time sales representative to develop relationships with employer groups within Hawaii. The successful candidate must reside on Oahu and will be responsible for aligning product offerings with group needs, implementing sales strateg ...

The Health Plan Navigator guides members through the complexities of HMSA's health plan benefits and programs.The Navigator will assist and build relationships with customers primarily by phone, · and will also provide support in-person, · virtual, · and through online servicing ...

Sustains mastery of encounter system processes within HMSA and external partners for multiple lines of business. · ...

Job summary: Hybrid Work Environment - Must reside on Oahu. · Position is responsible for optimizing encounter data submissions and collaborating with other departments. Minimum Qualifications: Bachelor's degree and one year related experience; or an equivalent combination of edu ...

The claims manager oversees day-to-day claims operations ensuring timely fair efficient processing of claims in accordance with company policies regulatory requirements and customer expectations. · Managing a team of claims liaisons external service providers optimizing workflows ...

The Senior Accounts Payable Clerk is responsible for prioritizing approved invoices and check requests according to payment terms. · Prioritizes approved invoices and check requests according to payment terms. Assist with month-end accruals as needed.Familiarizes with company pol ...

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 of financial data. Compiles data that is obtained from other ...

Analyzes encounter system processes within HMSA and external partners. · Coordinates and reconciles exchange of data with external entities. · Researches various claim-member-provider scenarios to determine root cause of data submission errors. · Participates in discussions with ...

The Business Architect will identify opportunities for business architecture modeling within the organization. They engage stakeholders to assess the business value of proposed business architecture requests and collaborate with stakeholders to identify business owners and projec ...

The Community Health Worker (CHW) serves a critical role in advancing health and wellness within the community by fostering trust, advocacy for individuals and families, and facilitating timely access to appropriate care. · ...

The Community Health Worker (CHW) promotes health and wellness by building trust, advocating for members, and ensuring timely appropriate care. · ...