Job Details

Hybrid Work Environment – Must reside on Oahu.

Employment Type

Full-time (Exempt)

Pay Range

$68,000 to $133,000, position eligible for an incentive bonus; individuals typically begin between the minimum and the middle of the pay range.

Minimum Qualifications

• Bachelor's degree and five years of related work experience; or an equivalent combination of education and related work experience.
• One year of experience in a management/supervisory/leadership role.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Basic knowledge of Microsoft Office applications, including Word, Excel, and Outlook.

Duties and Responsibilities

• Manage staff, ensuring provider inquiries are responded to timely, accurately, and professionally. Resolve complex provider inquiries.
• Respond to and oversee staff responding to CMS demand letters.
• Participate in ad hoc projects to enhance the provider experience with HMSA, such as enhancements of provider online resources and development of content for the HealthPro news and the Provider Resource Center.
• Analyze relevant data sources to proactively identify and resolve issues affecting providers.
• Oversee training activities and the creation of training materials, workflows, and desktop procedures; prepare and conduct presentations for staff and management.
• Develop staff to ensure continual growth and opportunities while maximizing efficiency for providers and the department.
• Integrate Claims Adjustment Specialists into the Research and Correspondence unit by implementing a plan for the pending resolutions to be worked and ensuring audit compliance.
• Lead the Research and Correspondence team in technological initiatives, including existing application upgrades, adopting new applications, and ongoing refinement of the team's use of the SalesForce application.
• Coordinate reporting requirements for the unit, including inventory management reports and ad hoc claim queries.
• Perform all other miscellaneous responsibilities and duties as assigned or directed.

Seniority Level

Mid-Senior level

Job Function

Research, Analyst, and Information Technology

Industries

Insurance