- Pay Range: $47,500 - $88,000
- Individuals begin between the minimum to middle of the pay range
- Bachelor's degree and three years of related work experience; or equivalent combination of education and work experience
- Effective verbal and written communication skills
- Intermediate level knowledge of Microsoft Office applications including Word, Outlook, Excel, and Power Point
- Collect, analyze, and utilize data and feedback related to Claims to identify improvement opportunities between the business and other entities
- Direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO)
- Compile reports about incidents, events, and updates regarding claims processing issues and conflicts
- Gather, review, and analyze information to identify trends, issues, and potential problems related to development and implementation including new products, services, contract deliverables, enhancements to add functionality, and redesigns of systems
- Initiate the development of strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values
- Provide critical assessments of information and data about current trends and issues to encourage collaboration for improvement and change
- Translate analysis into solutions and options for consideration of specific HMSA actions
- Conduct ongoing research and analysis to assess changing industry needs
- Communicate with vendors and internal stakeholders to obtain or provide information regarding claims processing updates
- Work directly with cross-departmental team members and external partners to monitor and distribute information
- Conduct presentations to all levels of the organization and vendor partner
- Communicate process changes to vendors to stay current with guidelines
- Engage and collaborate with staff and subject matter experts in project efforts
- Advise in the development of requirements, reports, budgets, and other analyses
- Organize and maintain all references, documents, and procedures related to claims
- Proactively solve conflicts and address issues between stakeholders
- Maintain knowledge of current health plan requirements
- Perform all other miscellaneous responsibilities and duties as assigned
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Operations Specialist
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Claims Operation Specialist
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Claims Operation Specialist
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Claims Operation Specialist
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Claims Operation Specialist
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Claims Operation Specialist - Honolulu, United States - Hawaii Medical Service Association
Description
The Claims Operation Specialist tracks, analyzes, and resolves claims and related system issues while collaborating with vendors to streamline operational processes. In this role, the Specialist monitors vendor adherence to Service Level agreements, tracks issues, and works with multiple areas to ensure HMSA meets all claim goals and objectives.
Minimum Qualifications
Duties and Responsibilities
