Job Description: Analyzes, researches, and interprets medical and claims data while processing authorization.... Refers requests to Medical Directors for determination when appropriate following department and regulatory guidelines...
reliability of the systems operating or network environment, and plans the implementation of new IT service enhancements... if inactive accounts should be deleted. Supervises the installation of system upgrades and service packs. Monitors service level...
, ensuring timely resolution and maintaining a high level of service and meeting SLA response times. Manage inventory of agency... of Hawaii Department of Commerce and Consumer Affairs or pass all four sections of the state licensing examination within three...
to compliance guidelines including but not limited to HIPAA Core Rules, Washington Publishing Company Updates, BCBS Association... work effort for Disbursements functions such as recovery of provider negative balance, review and reconciliation of medical...
department and external service providers to enhance claims platforms and integrate automation, AI, and data analytics tools... responsibilities and duties as assigned or directed. Support relationship(s) with service providers as applicable. #LI-Hybrid...
, endpoint protection, etc.). Strong customer service skills. Strong process and project management skills. Intermediate...
Job Description: Stakeholder Support: Support product managers by eliciting stakeholder input, documenting product needs, and participating in discussions across the product lifecycle. Assist with stakeholder communications to clarify g...
Job Description: Data Analysis and Reporting Conduct high quality, objective analysis to support performance optimization and strategic initiatives. Collect, interpret, and evaluate Key Performance Indicators (KPIs) and related info...
Job Description: Strategic Leadership: Develop and execute the organization's payment integrity strategy, aligning with enterprise cost containment goals. Oversee the design and implementation of pre-pay and post-pay review processe...
Job Description: Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, ...
Job Description: Lead as an IO Audit and Control Subject Matter Expert (SME) on process and controls. Review and monitor design of IO controls department-wide with the purpose of identifying ineffective or inefficient processes and advis...
Job Description: Manage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the esc...
Job Description: Oversees development and implementation of HMSA's provider contracting strategy and the primary team responsible for execution of provider contracts. Leadership Provide direction and guidance to staff on provider...
Job Description: 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 custom...
Job Description: Oversee and manage accounting operations for HMSA and its subsidiaries, including general ledger and reconciliation activities. Streamline processes and implement efficiencies to optimize financial operations. Ensure ac...
Job Description: 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 o...
Job Description: Coordinates various projects as assigned. Develops system requirements, test plan, test scenarios, test cases, anticipated test results and objectives and acceptance criteria. Also, performs testing, communicates status/...
Job Description: Conducts implementation and monitoring activities for a variety of HR programs; typically supports multiple teams/ department within a function. Identifies opportunities to enhance the employee experience and partners w...
. We offer a comprehensive benefits package that may include medical, dental, and vision coverage, life insurance, a retirement plan, employee.... Job Description: Job Description Allied Universal® is hiring a Regional Trainer in Honolulu, Hawaii. The Regional Trainer will teach Allied Universal...
(Hawaii) Basic Life Support from American Heart Association Advanced Cardiac Life Support within 12 months of hire...Primary Location Honolulu, Hawaii Schedule Part-time Shift Night Salary $47.64 - $68.06 / hour Job Number 1352585...