Kapolei, Hawaii, United States · Hybrid
Evaluation, interpretation, and processing of clinical review requests to include but not limited to applying the following requirements: Validation that requests has met submission requirements based on accreditation / …
Skills: Clinical review, Utilization management, Medical terminology, CPT coding, HCPCS coding
Honolulu, Hawaii, United States · Hybrid
Support Medical Management (MM)'s business solution requirements for the department through data reporting from various HMSA system applications and analytics utilizing established techniques or tools. Solicit, document …
Skills: Data reporting, Business requirements analysis, System implementation, Utilization management, Project management
Honolulu, Hawaii, United States · Hybrid
Prioritizes approved invoices and check requests according to payment terms. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensu…
Skills: Accounts Payable, Dynamics GP, Certify, CentreSuite, Expense Report Processing
Honolulu, Hawaii, United States · On-site
General Administrative Support Relieves the CEO/assigned Executive(s) of majority of administrative functions and tasks, ensuring the most effective/efficient use of the Executive's attention and focus. Drafts routine an…
Skills: Administrative support, Calendar management, Travel coordination, Corporate communications, Project management
Honolulu, Hawaii, United States · Hybrid
Oversee daily cash positioning, concentration, and funding/settlement across HMSA legal entities. Support oversight of corporate banking and financial institution relationships, primarily related to treasury, cash manage…
Skills: Cash management, Treasury operations, Liquidity forecasting, Financial modeling, Investment policy compliance
Honolulu, Hawaii, United States · On-site
Oversee and manage the quality assurance program for Customer Relations contact center operations. Conduct and/or supervise live call monitoring and recorded interaction reviews to evaluate service quality, policy compli…
Skills: Quality Assurance, Call Center Operations, Performance Management, Coaching, Data Analysis
Honolulu, Hawaii, United States · On-site
Strategic planning and project management Develop and contribute to strategic communications plans to ensure the delivery of meaningful, clear, concise, relatable messaging that supports HMSA's goals and initiatives. Ens…
Skills: Strategic planning, Project management, Communications strategy, Content development, Team leadership
Honolulu, Hawaii, United States · Hybrid
Business & Requirements Analysis Collaborate closely with business stakeholders, product owners, business analysts, and subject matter experts to understand business processes and requirements. Facilitate requirement rev…
Skills: Quality Assurance, Test Management, Test Execution, Agile Methodologies, Test Automation
Honolulu, Hawaii, United States · Hybrid
Lead and manage AI/Automation development, machine learning, data engineering, and automation delivery teams. Set strategic direction, delivery priorities, architecture guardrails, and development standards for AI and au…
Skills: AI Strategy, Automation Development, Data Governance, Machine Learning, Data Engineering
Honolulu, Hawaii, United States · Hybrid
Manages community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery, resiliency, and wellness. Advocate and support members and their fami…
Skills: Community health management, Case management, Motivational interviewing, Care coordination, Health education
Honolulu, Hawaii, United States · Hybrid
Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan. This detail…
Skills: Clinical judgment, Utilization review, Medical necessity criteria, Case management, Patient advocacy
Kapolei, Hawaii, United States · On-site
Successfully progress through and complete on-the-job training to respond verbally, in person and in writing to internal and external customer's inquiries on enrollment, eligibility, benefits and claims adjudication ques…
Skills: Customer Service, Claims Adjudication, Problem Solving, Verbal Communication, Written Communication
Honolulu, Hawaii, United States · On-site
Assist customers in a timely and accurate manner in phone interactions. Maintain quantity, timeliness, accuracy, and quality performance within established standards that support HMSA's ability to comply with customer pe…
Skills: Customer Service, Analytical Skills, Problem Solving, Microsoft Word, Microsoft Excel
Honolulu, Hawaii, United States · Hybrid
Product Strategy & Portfolio Management Own the end to end product strategy for the assigned segment, including benefit design, competitive positioning, rate considerations, and portfolio optimization. Establish short an…
Skills: Product Strategy, Portfolio Management, Competitive Analysis, Benefit Design, Regulatory Compliance
Honolulu, Hawaii, United States · Hybrid
Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and IT leadership to develop multi‑year category strategies for IT & Technology Operations vendors. Lead execution of IT vendor strategy, en…
Skills: Category Strategy, Strategic Sourcing, IT Contract Negotiation, Vendor Governance, Cloud Consumption Optimization
Honolulu, Hawaii, United States · Hybrid
Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and operations leadership to develop multi-year category strategies for Healthcare operations vendors. Lead execution of operations vendor s…
Skills: Category Management, Strategic Sourcing, Vendor Governance, Contract Negotiation, Financial Modeling
Honolulu, Hawaii, United States · Hybrid
Category Strategy and Planning Partner with the Chief Procurement Officer (CPO) and business leaders to develop multi‑year category strategies for business services aligned to enterprise priorities. Partner with business…
Skills: Category Strategy, Strategic Sourcing, Contract Negotiation, Vendor Governance, Financial Modeling
Honolulu, Hawaii, United States · Hybrid
Product Program Management: Manages product-related programs, product launches, projects, initiatives, and workstreams to ensure timely, coordinated, and effective execution across the product lifecycle: Develops and man…
Skills: Program Management, Product Management, Project Planning, Vendor Management, Stakeholder Engagement
Honolulu, Hawaii, United States · Hybrid
Conduct open enrollment benefit presentations (second sale), handle current and prospective member inquiries, and support benefit/health fairs at employer sites on Oahu and the Neighbor Island (in-person and/or virtual).…
Skills: Benefit Presentations, Sales, Member Relations, Strategic Planning, Public Speaking
Honolulu, Hawaii, United States · Hybrid
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 bac…
Skills: Data Management, Statistical Analysis, Predictive Analytics, Linear Regression, Time Series Analysis
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The Medical Management Specialist evaluates and processes clinical review requests while ensuring compliance with accreditation and regulatory requirements. They also manage authorization files, resolve provider inquiries, and maintain accurate documentation within utilization management systems.
Candidates must possess an associate's degree or equivalent work experience along with strong verbal and written communication skills. Proficiency in medical coding, terminology, and basic office software applications is required.
Improving the lives of our members and the health of Hawaii. #hmsahawaii #teamhmsa
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
Offices: 818 Keeaumoku Street, Honolulu, Hawaii 96814, US
Improving the lives of our members and the health of Hawaii. #hmsahawaii #teamhmsa
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
Offices: 818 Keeaumoku Street, Honolulu, Hawaii 96814, US
