Case Resolution Specialist I
Honolulu,
Hawaii
HMSA
Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements. Secures information from int...
22d
Behavioral Health Navigator
Honolulu,
Hawaii
HMSA
Assessment Provide telephonic screening of BH members using PHQ-9, GAD, and other CM-DM diagnostic tools to determine additional care support needs. Communication Communicates with HMSA members, physicians, case managers, and disease manage...
22d
Corporate Advanced Analyst I
Honolulu,
Hawaii
HMSA
Data Management: Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, goes back to source if probl...
22d
Network Policy Analyst
Honolulu,
Hawaii
HMSA
Fee Reviews Lead the Fee Review Process which includes analyzing and explaining complex policy and reimbursement issues to providers, Professional Reimbursement and HMSA leadership Prepare cases for Operations Management Committee decision ...
24d
MS Billing & Research Specialist I
Honolulu,
Hawaii
HMSA
Research member billing issues and routine group billing issues; effectively communicate (written, telephonically or in person) the outcome of the research and resolution to the issue in a timely manner. Ensure appropriate approval levels a...
24d
Network Management Representative
Honolulu,
Hawaii
HMSA
a. Responsible for initiating and providing face-to-face support to new providers interested in joining HMSA's network. This includes, but is not limited to, contracting and on-boarding to ensure that there are no unnecessary delays in the ...
24d
Principal System Engineer
Honolulu,
Hawaii
HMSA
Design Solutions: Serve as a technical leader on our most demanding, cross-functional projects. Balance technical leadership with strong business judgment to make the right decisions about technology choices. Decompose complex problems into...
24d
Senior Manager, Member Advocacy & Appeals
Honolulu,
Hawaii
HMSA
Responsible for managing day-to-day operations of the Member Advocacy and Appeals Department including the investigation and resolution of cases, compliance with required processes, tracking, reporting, notifications to members and provider...
24d
Account Servicing Advocate I
Honolulu,
Hawaii
HMSA
Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and collaborating with other unit...
26d