Senior Manager, Member Advocacy & Appeals
Honolulu,
Hawaii
HMSA
Responsible for managing day-to-day operations of the Member Advocacy and Appeals Department including the investigation and resolution of cases, compliance with required processes, tracking, reporting, notifications to members and provider...
6d
Account Servicing Advocate I
Honolulu,
Hawaii
HMSA
Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and collaborating with other unit...
8d
Nurse Reviewer - Clinical Review Unit
Kapolei,
Hawaii
HMSA
Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes ev...
8d
Quality Assurance Trainer II
Kapolei,
Hawaii
HMSA
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 identify training need...
8d
Business Analyst I - Medicare Programs
Honolulu,
Hawaii
HMSA
Coordinate and monitor activities with appropriate MP and operational departments to ensure that standards are being met timely and accurately; escalate issues as needed. Conduct analysis of ad hoc and questions, research issues, and provid...
9d
Senior Software Engineer - Data Integration
Honolulu,
Hawaii
HMSA
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 support activities. Lead...
9d
Healthcare Services Analyst I
Honolulu,
Hawaii
HMSA
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 with internal departme...
9d
Business Analyst II - Medicare Programs
Honolulu,
Hawaii
HMSA
Support the administration and management of the day to day operational activities needed to comply with CMS requirements and HMSA standards. Be knowledgeable on all CMS regulations and HMSA operational standards. This duty requires the ana...
9d
Senior Auditor I
Honolulu,
Hawaii
HMSA
Under the general guidance of the Audit Manager: Perform audit support functions related to risk-based, operational, compliance, financial, and information technology audits, and consulting projects for HMSA. Assist in the execution of audi...
9d
Solution Architect
Honolulu,
Hawaii
HMSA
Responsibilities include, but are not limited to the following: Influence information strategy: By partnering with business unit leadership, and through the rationalization of the information value chain, the information architect will prov...
9d