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Posted: Saturday, February 3, 2018 1:13 AM

Company:Hawaii Medical Service Assn.Job Title:Claims Benefit Examiner IExempt or Non-Exempt:Non-ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:The purpose of Claims Administration is to provide HMSA members and providers exemplary service through the accurate and timely processing of medical claims. A Claims Benefit Examiner is required to review and make benefit determinations on medical claims in accordance with HMSA s claim processing guidelines. This involves identifying coding discrepancies, verifying eligibility, determining coverage in accordance with the Plan design, and applying cost containment measures to assist in the claim adjudication process.Duties and Responsibilities:
Process claim suspensions from the system to correct processing discrepancies by reviewing online information while applying HMSA policies and procedures.
+ Prioritize workload to meet customer expectations and department quality, production, and guidelines.
+ Concurrently access and utilize multiple databases, software programs, and/or online tools to perform required functions.
+ Meet or exceed performance objectives and competencies.
+ Improve claims payment accuracy by identifying pricing inconsistencies and reporting to the QA Trainer.
+ Attend training as directed by Supervisor.
+ Other duties as assigned.
Minimum Qualifications:
+ Two-year degree from college or university or at least one year of experience as a Benefits Examiner Trainee or equivalent combination of education and relevant work experience.
+ Must be able to read, analyze and interpret business documents such as HMSA s Medical Policy Manual, plan certificates, statistical data, marketing memos and documents published by Blue Cross and Blue Shield Association related to program compliance; Federal and/or state government s documentation pertinent to HMSA s business (i.e., Federal Register, Medicare guidelines, Hawaii Revised Statutes (H.R.S.).
+ Must have good communication skills.
+ Must have the ability to interact with all members of the team, as well as across functional boundaries
+ Must be able to calculate figures and amounts such as discounts, interest, proportions, andpercentages.
+ Must be able to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
+ Must be able to interpret a variety of instructions furnished in written, oral, diagram and/or schedule form.
+ Must be able to learn and gain knowledge of health insurance plans and benefits and coding used in HMSA s business, such as CPT-4, ICD9-CM, HCPCS, or medical terminology.
+ Must have basic knowledge of Microsoft Word and Excel programs.
+ Work hours are generally during HMSA s business hours with overtime as determined by HMSA s business needs on some weekends.
EEO/AA/Disability/Vets Employer
Associated topics: adjuster, auto, bodily, claimant, damage, fraud, insurance, insurance adjuster, investigate, liability adjuster


• Location: Honolulu (Oahu)

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