Title Claims Processor
Job Title/Position Claims Processor
Job Description

The responsibilities of this position are to process, research, and adjust claims in accordance with plan documents and administrative guidelines. All applicants must have the ability to maintain a courteous and professional demeanor in providing Customer Service; Ability to work under pressure, prioritize tasks and carry them through to completion in a timely and efficient manner; Ability to problem solve, research, document and communicate results while working independently.

 

Job Tasks/Deliverables:

  • Problem solve issues involving claims and claims payment
  • Accurate and timely processing, researching, and adjusting of claims
  • Identify and resolve root cause of claim payment errors
  • Research and recreate member and/or provider EOBs
  • Provide written analysis and response regarding claim cases
  • Other duties as assigned

Education Required:

High School Diploma or equivalent, Computer Classes and Medical Terminology Knowledge preferred.

Experience Required:

  • Excellent oral and written communication
  • Ability to work independently and as part of a team
  • Detail oriented
  • Data entry Experience
  • 10-key
  • ICD/CPT/HCPCS coding
  • PC literate
  • Managed care or health care background preferred

Employment Type:

Full Time

Hours:

8:00am – 5:00pm

Compensation:

HMA offers a competitive compensation package including full medical, dental, and visions benefits, 401K match, Active&Fit Membership, paid holiday, and paid-time off.

Location Honolulu, Hawaii
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Title Client Service Representative
Job Title/Position Client Service Representative
Job Description

The responsibilities of this position are to provide customer service to all clients, participants and providers that call or walk into the HMA Hawaii office. All applicants must have the ability to maintain a courteous and professional demeanor in providing Customer Service; Ability to work under pressure, prioritize tasks and carry them through to completion in a timely and efficient manner; Ability to problem solve, research, document and communicate results while working independently.

Job Tasks/Deliverables:

  • Problem solve issues involving claims and claims payment
  • Quote benefits accurately from designated plan documents/SPD
  • Verify enrollment/eligibility accurately
  • Maintain average hold times under 30 seconds
  • Resolve call inquiries during the initial contact
  • Document and distribute claims adjustments/research on RAC Forms
  • Document calls using member notes
  • Return all messages within 24 hours
  • Respond to written inquiries within 24 hours
  • Greeting Walk-ins and Client Meetings
  • Phone coverage at the Reception desk
  • Other duties as assigned by department manager

Education Required:

High School Diploma or equivalent, Computer Classes and Medical Terminology Knowledge preferred.

Experience Required:

PC literate, Customer Service, Managed care or health care background preferred.

Employment Type:

Full Time

Hours:

8:00am – 5:00pm

Compensation:

HMA offers a competitive compensation package including full medical, dental, and visions benefits, 401K match, Active&Fit Membership, paid holiday, and paid-time off.

Location Honolulu, Hawaii
Apply Now