- People Who Care
- Professional Growth
- Benefits & Perks
- Opportunity to Give Back
- Manage medical only, lost time, and disfigurement claims. The assignment is based on the assessment and determination of the Manager. Training will be provided.
- Review First report (WC- 1) for accuracy and completion.
- Complete 24-hour three-point contact with Claimant, Employer, and Physician. Secure formal statements from injured workers as deemed appropriate.
- Calculate average weekly wages and compensation rate. Issue timely indemnity benefits in compliance with H.R.S. 386.
- Identify any potential third party (subrogation).
- Process medical bills in compliance with Hawaii State Medical Fee Schedule and Claim Best Practices.
- Develop and collaborate to implement claim strategies to facilitate case resolution.
- Document and work within all Claim-related systems including but not limited to Guidewire, Image Right, My Matrix (Express Scripts), and IQ Review (AMC Bills).
- Complete reinsurance reporting of financial exposures meeting the criteria ($250,000.00 and/or catastrophic).
- Establish reserves based upon Probable Ultimate Cost.
- Attend hearings before the Director as deemed appropriate by Claim Management and claim reviews on dedicated accounts as needed.
- Maintain current diary.
- Other duties as assigned.
- Basic understanding of workers' compensation laws, rules, and regulations (preferred).
- Current Hawaii Workers' Comp Adjusters License (preferred).
- Familiarity with medical and legal terminology (preferred).
- Willingness to learn and develop professionally.
- Excellent customer service skills, accuracy, attention to detail, and communication (written and verbal).
- Ability to maintain confidential information.
- Able to work independently as well as collectively as a team.
- Proficiency with Microsoft Office Suite.
- Self-directed and flexible.
-
claims specialist
1 week ago
BrightSpring Health Services Honolulu, United States· CLAIMS SPECIALIST - 3RD PARTY · Job Locations · US-HI-HONOLULU · ID · Line of Business · PharMerica · Position Type · Full-Time · Pay Min · USD $19.00/Hr. · Pay Max · USD $19.00/Hr. · Our Company · PharMerica · Overview · Join our PharMerica team PharMerica is a closed-door ...
-
claims specialist
1 week ago
BrightSpring Health Services Honolulu, United StatesCLAIMS SPECIALIST - 3RD PARTY · Job Locations · US-HI-HONOLULU · ID · Line of Business · PharMerica · Position Type · Full-Time · Pay Min · USD $19.00/Hr. · Pay Max · USD $19.00/Hr. · Our Company · PharMerica · Overview · Join our PharMerica team · PharMerica is a ...
-
claims Specialist
1 week ago
ResCare Honolulu, United StatesOur Company · PharMerica · Overview · Join our PharMerica team PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high ...
-
claims Specialist
1 week ago
ResCare Honolulu, United StatesOur Company · PharMerica · Overview · Join our PharMerica team PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in hi ...
-
claims specialist
1 week ago
PharMerica Honolulu, United StatesOur Company · PharMerica · Overview · Join our PharMerica team · PharMerica is a · closed-door pharmacy · where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy · environment. Our organizat ...
-
Claims Operation Specialist
2 weeks ago
Hawaii Medical Service Association Honolulu, United StatesJob Summary · Pay Range: $47,500 - $88,000 · Note: Individuals typically begin between the minimum to middle of the pay range · The Claims Operation Specialist tracks, analyzes, and resolves claims and claims related system issues while collaborating with our vendor to streamli ...
-
Claim Specialist WC
6 days ago
HEMIC Honolulu, United StatesJoin us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our business is founded on caring fo ...
-
Claims Operation Specialist
5 days ago
Hawaii Medical Service Association Honolulu, United StatesNote: · Individuals typically begin between the minimum to middle of the pay range · The Claims Operation Specialist tracks, analyzes, and resolves claims and claims related system issues while collaborating with our vendor to streamline operational processes. In this role, the ...
-
Claim Specialist WC
3 weeks ago
HEMIC Honolulu, United StatesJob Description · Job DescriptionJoin us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: · People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our ...
-
Claim Specialist WC
1 week ago
HEMIC Honolulu, United StatesJob Description · Job Description · Join us at HEMIC · Voted one of Hawai`i Business' Best Places to Work for 5 Years in a Row · As a HEMIC employee, you will get: · People Who Care · Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplac ...
-
LTD Claims Specialist
1 week ago
Lincoln Financial Group Honolulu, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · Alternate Locations: · Charlotte, NC (North Carolina); Dover, NH (New Hampsh ...
-
Claims Operation Specialist
6 days ago
HMSA Honolulu, United StatesCollect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation M ...
-
ESIS Claims Specialist, WC
3 weeks ago
Chubb Honolulu, United StatesESIS, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk ...
-
Claims Operation Specialist
2 weeks ago
Hawaii Medical Service Association Honolulu, United StatesJob SummaryPay Range: $47,500 - $88,000Note: Individuals typically begin between the minimum to middle of the pay rangeThe Claims Operation Specialist tracks, analyzes, and resolves claims and claims related system issues while collaborating with our vendor to streamline operatio ...
-
Life Claims Specialist
1 week ago
Lincoln Financial Group Honolulu, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · Alternate Locations: · Work from Home · Work Arrangement: · Remote : Work at ...
-
Claims Operation Specialist
3 weeks ago
HMSA Honolulu, United StatesCollect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation M ...
-
Specialist, Default FHA MI Claims, II
5 days ago
Carrington Honolulu, United StatesCome join our amazing team and work remote from home · The Default FHA Claims Specialist II will work under moderate supervision, be responsible for preparing, filing, and following up on FHA claims timely and accurately according to insurer/investor guidelines. Performs all duti ...
-
Integrated Absence Claims Specialist
2 weeks ago
Lincoln Financial Group Honolulu, United StatesLincoln Financial Group · Integrated Absence Claims Specialist · Honolulu , · Hawaii · Apply Now · Alternate Locations: · Work from Home; Boise, ID (Idaho); Omaha, NE (Nebraska); Phoenix, AZ (Arizona); Sacramento, CA (California); San Diego, CA (California); San Francisco, ...
-
Entry-Level Claims Specialist
1 week ago
ALTRES Staffing Honolulu, United States Full timeEntry-Level Claims Specialist (Workers' Comp Work for a local insurance company, voted one of Hawaii's Best Places to Work · As the Workers' Comp Claims Specialist, you will manage workers' compensation claims for medical only, lost time, and disfigurement. A current Hawaii worke ...
-
Short Term Disability Claims Specialist
2 weeks ago
Lincoln Financial Group Honolulu, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · Lincoln Financial Group · Short Term Disability Claims Specialist · in · H ...
Medical Claim Specialist - Honolulu, United States - HEMIC
Description
Job Description
Job DescriptionJoin us at HEMIC
Voted one of Hawai`i Business' Best Places to Work for 6 Years in a Row
As a HEMIC employee, you will get:
Voted one of Hawai`i Business' Best Places to Work, and Pacific Business News' Best Workplaces, our business is founded on caring for Hawai`i workers, Hawai`i businesses, and each other.
We're passionate about your development. Whether it's achieving a formal certification or attending a workshop to improve your communication skills, we will support and encourage you to grow.
We offer competitive salary and best-in-class benefits, including a 401k match, flex-time, generous PTO, 15 paid holidays, and so much more
Giving back to our community is our kuleana and we offer numerous opportunities for our employees to take part - whether it be volunteering for a fundraiser, attending a charity walk, or getting a match for your charitable contributions.
Why our Medical Claim Specialist is Important:
A company buys insurance for financial security. When an injury or loss occurs, the claimant expects to receive treatment and compensation in a timely manner. Delivery on this is the heart of the claims function and process. Our Medical Claim Specialist carries out our promise of "Proudly Taking Care of Hawai`i" by working with injured workers to get the necessary care so that they can get back to work and life. Training will be provided.
Essential Duties
Requirements
Position title
Medical Claim Specialist
Department
Claim
Work Arrangement
In-Person, HEMIC Tower
Reports To
Manager, Claim
Direct Reports
N/A
FLSA Status
☒ Exempt ☐ Non-Exempt Job Class: 2-Prof
Approved By:
clewis
Date Approved:
4/23/2024
Reviewed:
N/A
NOTE: The above information on this job description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory, or all duties, responsibilities, and qualification of employees assigned to this job. Management has the right to add, revise or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential duties of this position.
