Hawaii Medical Service Association Verified
Health Insurance, Healthcare
Claims Liaison Specialist
Honolulu, HIHybridFull TimePosted 2 months agoVisa sponsorship available
Required skills
- claims processing
- process improvement
- operational quality
- stakeholder management
- Microsoft Office
- compliance
- SLAs
- regulatory standards
- case management systems
Nice to have
- training delivery
- system updates
- audits
- appeals
Role summary
The Claims Liaison Specialist acts as a key communication hub between claims processing teams and internal/external partners. This role involves investigating and resolving escalated claims, managing open issues to ensure timely resolution in compliance with SLAs and regulations, and coordinating with departments to implement process improvements. The specialist will also support training initiatives, audits, appeals, and compliance activities, while maintaining clear documentation in claims systems. A hybrid work model is offered.
- Function as a central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions.
- Investigate and resolve escalated claims and trends, including denied or delayed claims, by coordinating with relevant departments to implement short- and long-term solutions and process improvements.
- Manage open claims issues to ensure timely resolution in compliance with internal SLAs and regulatory standards.
- Collaborate with internal teams to conduct training sessions and measure effectiveness of training.
- Provide support for audits, appeals, and compliance-related activities
- Participate in system updates, and cross-functional meetings to stay current on claims processing procedures and benefit plan designs.
- Document all interactions, updates, and outcomes clearly in case management or claims systems.
- Performs all other miscellaneous responsibilities and duties as assigned or directed
- Associates degree and two years of related work experience; or equivalent combination of education and related work experience.
- Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner.
- Knowledge of process improvement methodologies.
- Knowledge of methodologies for driving increased operational quality.
- Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.
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