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HMSA · 12 hours ago

Claims Liaison Coordinator

Honolulu, HI

Full-time

Hybrid

Mid Level

$53K/yr - $99K/yr

3+ years exp

HMSA is a health insurance provider in Hawaii, and they are seeking a Claims Liaison Coordinator to act as a vital link between internal and external partners. The role involves researching, analyzing, and resolving complex claim issues while ensuring compliance with regulatory requirements and enhancing claims performance.

AssociationHealth CareInsuranceMedical

Responsibilities

Serve as the primary liaison for complex escalated claim inquiries from providers, members, account management, and internal departments

Research and resolve complex claim discrepancies, denials, adjustments, and payment issues within established service-level agreements (SLAs)

Coordinate with claims examiners, configuration, and payment integrity teams to ensure accurate claim adjudication

Document and maintain claim processing instructions and workflows to ensure accurate and efficient processing

Provide guidance and mentoring to Claims Liaison Specialists

Perform root-cause analysis of claim errors, payment delays, and provider/member complaints

Compile and present findings to leadership with recommended solutions

Track claim trends and prepare reports on recurring issues, financial impact, and compliance risks

Provide clear and timely communication of claim resolutions to providers, members, and internal stakeholders

Develop strong working relationships with provider relations, customer service, utilization management, and network management teams

Function as a subject-matter resource on claim workflows and policies

Identify opportunities to improve claims workflows, system configuration, and provider/member experience

Participate in cross-functional workgroups to implement corrective actions and process enhancements

Ensure adherence to state, federal, and accreditation guidelines (e.g., CMS, HIPAA, NCQA)

Performs all other miscellaneous responsibilities and duties as assigned or directed

Qualification

Claims ResolutionProcess ImprovementRoot-Cause AnalysisMicrosoft OfficeEffective Communication

Required

Associates degree and three 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