What are the responsibilities and job description for the Manager, Claims position at Hawaii Medical Service Association?
- 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 escalation point for complex or disputed claims and drive resolution within defined SLA.
- Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction
- Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely claims processing.
- Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
- Contribute to the development and implementation of new policies, procedures, and systems to improve claims operations.
#LI-Hybrid
Qualifications:
- Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
- Three years of experience in management, preferably within health insurance; or equivalent combination of leadership experience or experience leading teams.
- In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans
- Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge)
- Effective written and verbal communication skills
- Intermediate working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.