What are the responsibilities and job description for the Claims Liaison Specialist position at Hawaii Medical Service Association?
- Function as a central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions.
- Investigate and resolve escalated claims and trends, including denied or delayed claims, by coordinating with relevant departments to implement short- and long-term solutions and process improvements.
- Manage open claims issues to ensure timely resolution in compliance with internal SLAs and regulatory standards.
Collaborate with internal teams to conduct training sessions and measure effectiveness of training. - Provide support for audits, appeals, and compliance-related activities
- Participate in system updates, and cross-functional meetings to stay current on claims processing procedures and benefit plan designs.
- Document all interactions, updates, and outcomes clearly in case management or claims systems.
- Performs all other miscellaneous responsibilities and duties as assigned or directed
#LI-Hybrid
- Associates degree and two years of related work experience; or equivalent combination of education and related work experience.
- Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner.
- Knowledge of process improvement methodologies.
- Knowledge of methodologies for driving increased operational quality.
- Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.