Kapolei, Hawaii, United States · On-site
Conducts audits in the operational areas to include: Monthly audits to monitor controls and performance. Document and review findings with operational staff and management. Track audit results and spot error trends to id…
Skills: Quality Auditing, Training Development, Root Cause Analysis, Medical Terminology, Health Industry Coding
Honolulu, Hawaii, United States · Hybrid
Manage 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 famil…
Skills: Community Health Management, Patient Advocacy, Care Coordination, Motivational Interviewing, Health Education
Keaʻau, Hawaii, United States · Hybrid
Manage 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 famil…
Skills: Community Health Management, Patient Advocacy, Care Coordination, Motivational Interviewing, Health Education
Kahului, Hawaii, United States · Hybrid
Performance Proactively service and grow HMSA products and services through various methods including site visits, on-line meetings, telephone and email correspondence, PowerPoint presentations, and one-on-one customer s…
Skills: Account Management, Sales, Relationship Management, Business Analysis, Presentation Skills
Honolulu, Hawaii, United States · On-site
Performance Pro-actively manage a base of accounts by strategically prioritizing account sales and service activities. Get ahead of the curve on known jeopardy accounts by strategically promoting the value in HMSA's solu…
Skills: Account Management, Strategic Planning, B2B Sales, Customer Relationship Management, Business Analysis
Honolulu, Hawaii, United States · Hybrid
Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs Lead and implement internal controls; facilitate definition of data and ot…
Skills: Financial Reporting, Data Analysis, Budgeting, Forecasting, Variance Analysis
Keaʻau, 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, Problem Solving, Analytical Skills, Verbal Communication, Written Communication
Honolulu, Hawaii, United States · Hybrid
Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program/pla…
Skills: Reimbursement Strategy, Provider Contracting, Financial Analysis, Budgeting, Forecasting
Honolulu, Hawaii, United States · Hybrid
Manage CFR Team You are responsible for leading and managing the contracting function in Provider Services and overseeing the work of the employees in the CFR department as well as outside contracted vendors. These respo…
Skills: Contract Negotiation, Provider Services Management, Strategic Planning, Personnel Management, Regulatory Compliance
Honolulu, Hawaii, United States · On-site
Financial Performance Management & Business Planning Leads program-level financial performance routines (budget tracking, variance drivers, and corrective action plans). Develops business cases and financial impact asses…
Skills: Financial Performance Management, Business Planning, Budget Tracking, Business Case Development, Project Management
Honolulu, Hawaii, United States · Hybrid
Facilitates complex projects and functions of high importance as an independent project lead. Plans and manages the project development process and oversees implementation. Analyzes intricate project objectives, data sou…
Skills: Data Reporting, Data Analysis, Project Management, Managed Care, Healthcare Business Processes
Honolulu, Hawaii, United States · Hybrid
Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to: Institutions, Professionals, and ancillary providers. Provide managem…
Skills: Provider Reimbursement, Financial Reporting, Data Analysis, Project Management, Staff Management
Kapolei, Hawaii, United States · Hybrid
Conducts audits in the operational areas to include: Monthly audits to monitor controls and performance. Document and review findings with operational staff and management. Track audit results and spot error trends to id…
Skills: Quality Assurance, Auditing, Training Documentation, Medical Terminology, Health Industry Coding
Honolulu, Hawaii, United States · Hybrid
Assessment & Planning May conduct comprehensive assessments, which could include physical, psychosocial, and health literacy evaluation, and interprets relevant diagnostic data to identify member and family needs. Apply …
Skills: Comprehensive Assessment, Care Planning, Medication Reconciliation, Care Gap Closure, Quality Improvement
Honolulu, Hawaii, United States · On-site
Research and Analysis: Research and respond to low complexity internal and external inquires. Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews wi…
Skills: Research and Analysis, SQL, MicroStrategy, Cost/Benefit Analysis, Claims Processing
Honolulu, Hawaii, United States · Hybrid
Maintaining Application Systems Prioritizes and coordinates application support efforts. Updates management on escalated issues on a regular basis. Supports and maintains Production incidents tracking on a daily basis by…
Skills: Application Support, ServiceNow, Resource Planning, Service Level Agreements, Strategic Planning
Honolulu, Hawaii, United States · Hybrid
Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application system(s). May participate in development, maintenance and supp…
Skills: Application Architecture, Systems Analysis, Software Design, Project Planning, Technical Specifications
Honolulu, Hawaii, United States · Hybrid
Stakeholder Engagement Builds and sustains strong relationships with executive leaders, business partners, and external stakeholders to advance strategic priorities and enterprise alignment. Evaluates complex business ch…
Skills: Enterprise Architecture, Cloud Operations, Business Architecture, Stakeholder Engagement, Strategic Leadership
Kapolei, Hawaii, United States · Hybrid
Performance Meet established marketing plan goals, and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities. Perform quick and efficient trans…
Skills: Sales, Customer Service, Account Management, Insurance Licensing, Proposal Preparation
Honolulu, Hawaii, United States · Hybrid
Revise and/or develop medical policies adopted from the BCBSA in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes approp…
Skills: Medical Policy Development, Research, Communication Skills, Organizational Skills, Time Management
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Conducts operational audits to monitor performance, identify error trends, and develop training documentation for staff. Supports business system changes through requirement review and project testing activities.
Requires an associate's degree and two years of related experience or an equivalent combination of education and experience. Must possess strong communication skills and working knowledge of medical coding and claim forms.
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
