Top 15 Senior claims specialist Jobs in Hawaii

Customer Service Representative
Gammie HomeCare —Lihue, HI
- $23 - $28 an hour
- 8 hour shift
- Writing skills
- HIPAA
- Mid-level
- Paid training
- Health insurance
Quick Apply
5d
Senior Claim Benefit Specialist - Remote
CVS Health —Hawaii
- $18.50 - $42.35 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Mentoring
- Health insurance
- Dental insurance
Senior Claims Specialist - Casualty
TRADEWIND GROUP INC —Honolulu, HI
- $90,000 - $105,000 a year
- Full-time
- 5 years
- High school diploma or GED
- Driver's License
Quick Apply
Administrator
Always Best Care Senior Services - Oahu —Honolulu, HI
- $90,000 - $125,000 a year
- Full-time
- Mid-level
- Office
- Administrative experience
Quick Apply
Senior Project Manager
Swinerton —Honolulu, HI
- $117,500 - $195,800 a year
- Full-time
- Construction site
- 8 years
- Business development
- AD&D insurance
- Paid holidays
Claims Adjuster Senior - Litigation
Progressive —Honolulu, HI
- $74,000 - $105,000 a year
- Hybrid work
- Customer service
- Office
- US work authorization
- Health savings account
- Disability insurance
IT SPECIALIST (PLCY/PLN)
US Immediate Office of the Chief of Naval Operations —Camp H M Smith, HI
- $111,119 - $144,457 a year
- Full-time
- Pass drug screening
- Continuous improvement
- Travel
Medicaid Payment Integrity SME
BerryDunn —Kapolei, HI
- $110,000 - $140,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- 5 years
- HIPAA
5d
Medicaid Program Integrity Senior Consultant
BerryDunn —Kapolei, HI
- $85,000 - $100,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- HIPAA
- Research
- Health insurance
- Dental insurance
President, Altais Hawaii Market
Altais Health Solutions —Hilo, HI
- $175,000 - $200,000 a year
- Full-time
- Background check
- 7 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Corporate UW Splst II to Technical Specialist
Tokio Marine North America (TMNA) —Honolulu, HI
- $64,000 - $118,200 a year
- Full-time
- Research
- Mid-level
- 3 years
- Profit sharing
- Disability insurance
Purchasing Specialist
Raynor Overhead Doors and Gates, Inc. —Pearl City, HI
- $22 - $26 an hour
- Full-time
- Mid-level
- Office
- In-person
- Paid holidays
- Dental insurance
Quick Apply
Safety Manager
Royal Hawaiian Movers Inc. —Honolulu, HI
- $75,000 - $90,000 a year
- Full-time
- Customer service
- 5 years
- English
- Paid holidays
- Health insurance
Quick Apply
11d

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Senior Claim Benefit Specialist - Remote
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BerryDunn —Kapolei, HI
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Customer Service Representative

Gammie HomeCare -
Lihue, HI

Quick Apply

Job Details

Full-time
$23 - $28 an hour
5 days ago

Benefits

Paid training
Health insurance
Dental insurance
401(k)
Paid time off
On-the-job training
Vision insurance
401(k) matching
Professional development assistance
Referral program

Qualifications

Customer communication
High school diploma or GED
Attention to detail
Organizational skills
Business Administration
Associate's degree

Full Job Description

The Customer Service Representative is a non-driving position responsible for supporting the Operations Team through multiple tasks required for the successful support of each region’s individual needs.

Essential Functions and Job Responsibilities:

Supports operations team with discovery and training as necessary with AdaptHealth processes.
Responsible for providing support during process improvement initiatives to assist with driving all areas of workflow, including verification, and data analysis.
Develop and maintain working knowledge of current products and services offered by the company
Must be familiar with payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services.
Working knowledge in all areas of AdaptHealth customer service, intake, daily operations and revenue cycle processes and workflows from beginning to end, which may include
Review all required documentation to ensure accuracy
Accurately process, verify, and/or submit documentation
Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required (if helping a region)
Navigate through multiple online EMR systems to obtain applicable documentation
Enter and review all pertinent information in EMR system including authorizations and expiration dates
Meet quality assurance requirements and other key performance metrics
Pays attention to detail and has great organizational skills
Actively listens to teams, region leaders and handle stressful situations with compassion and empathy.
Ability to analyze data and reports to identify execution errors in workflow, troubleshoot and fix the exceptions, advise staff on corrections.
Collaborate with the Operations Team on exceptions and solutions within workflow processes
Communicate with operations teams and leadership on an on-going basis regarding any noticed trends in process errors with insurance companies
Assist with various projects and tasks as needed for various unique processes
Participate in the effort to define, document, and refine processes, procedures and workflows for business operations based on industry and company best-practices.
Participate in the effort to create training materials and train client engagement and service teams
Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
Works with insurance verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments.
Assume on-call responsibilities during non-business hours in accordance with company policy.
Lead Responsibilities:
Supervise and provide guidance to team members in daily operations and complex case resolution
Lead team meetings and facilitate training sessions for staff development
Monitor team performance metrics and productivity standards, providing feedback and coaching as needed
Serve as primary escalation point for difficult customer issues and complex regulatory compliance questions
Develop and implement process improvements and workflow optimization strategies
Coordinate with management on staffing needs, scheduling, and resource allocation
Conduct new employee onboarding and ongoing training programs
Maintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisions
Prepare reports and analysis on team performance, trends, and operational metrics for management review
Maintains patient confidentiality and functions within the guidelines of HIPAA.
Completes assigned compliance training and other education programs as required.
Maintains compliance with AdaptHealth's Compliance Program.
Performs other related duties as assigned.

Competency, Skills and Abilities:

Excellent ability to communicate both verbally and in writing
Ability to prioritize and manage multiple tasks
Proficient computer skills and knowledge of Microsoft Office
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
Work well independently and as part of a group
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team

Requirements

Education and Experience Requirements:

High school diploma or equivalent required; Associate’s degree in healthcare administration, Business Administration, or related field preferred
Related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
Exact job experience is health care organization, pharmacy that routinely bills insurance or provides Diabetics, Medical Supplies, HME, Pharmacy or healthcare (Medicare certified) services
Specialist Level: (Entry Level):

One (1) year of work-related experience

Senior Level:

One (1) year of work-related experience plus

Two (2) years exact job experience

Lead Level:

One (1) year of work-related experience plus

Four (4) years exact job experience

Physical Demands and Work Environment:

Work environment will be stressful at times, as overall office activities and work levels fluctuate
Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
Subject to long periods of sitting and exposure to computer screen
Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.
Mental alertness to perform the essential functions of position.

Job Type: Full-time (40 hours per week)

Benefits:

401(k) matching
Dental insurance
Health insurance
On-the-job training
Paid time off
Professional development assistance
Referral program
Vision insurance

Shift:

Day shift

Work Location: In person

Job Type: Full-time

Pay: $23.00 - $28.00 per hour

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Paid time off
Vision insurance

Shift:

8 hour shift

Work Location: In person

Quick Apply

Refine Your Search

senior claims specialist jobs in hawaii

Customer Service Representative

Senior Claim Benefit Specialist - Remote

Senior Claims Specialist - Casualty

Administrator

Senior Project Manager

Claims Adjuster Senior - Litigation

IT SPECIALIST (PLCY/PLN)

Medicaid Payment Integrity SME

Medicaid Program Integrity Senior Consultant

President, Altais Hawaii Market

Corporate UW Splst II to Technical Specialist

Purchasing Specialist

Safety Manager

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