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HMSA · 3 days ago

Manager, Claims

Honolulu, HI

Full-time

Hybrid

Mid, Senior Level

$68K/yr - $133K/yr

5+ years exp

HMSA is seeking a Claims Manager to oversee the operations of the claims department within a hybrid work environment. The role involves managing a team, ensuring efficient claims processing, and driving continuous improvement initiatives to enhance service quality.

AssociationHealth CareInsuranceMedical

Responsibilities

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

Qualification

Claims managementManaged care knowledgeClaims adjudication systemsMicrosoft OfficeTeam leadershipEffective communication

Required

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