Claims Coordinator (QUEST)

  • Full Time
  • Kapolei
  • Posted 1 week ago

Hawaii Medical Service Association

Job Summary:

The Claims Coordinator position was established as a means to develop leadership skills and business knowledge for individuals interested in progressing towards a career in management. The Claims Coordinator provides operational guidance to various claims personnel by working with the unit’s Quality Assurance Trainers and Management Team. Some of the activities this coordinator will be responsible for include but are not limited to:

  • Assessing how current employee skill sets would be impacted as a result of system changes and new product implementation. Work with management to develop and implement a transitional plan to minimize adverse operational impacts.
  • Providing input on employees’ performance and coaching for individual performance management plans. Identifying, initiating, developing and coordinating project activities that will enhance or improve the unit’s operational performance while striving to reduce unnecessary administrative expense.
  • Work with management in the development and implementation of cohesive production teams comprised of QA Trainers, Examiners and other support staff.
  • Work closely with Supervisor/Section Supervisor and/or Manager to learn daily managerial responsibilities to include but not limited to: Timecards, Attendance Record keeping, YPT requests, employee PMP’s, Inventory Management.
  • Participating in Unit and Departmental Planning Activities to include the development and execution of Annual Department and Unit Plans.
  • Acting as a Unit representative and providing operational impact in inter-departmental meetings and assigned workgroups.

Duties and Responsibilities:

  1. Staff Development
  • With support from the Section Supervisor, Manager or Director, will develop and organize unit staff to use group and individual capabilities to maximize productivity and meet the unit’s business objectives. Provides feedback and coaching (i.e. problem resolution) to staff including interim and year-end performance reviews.
  • As a result of new products or project implementation a person occupying this position is expected to work with the QA Trainer / Specialist and Section Supervisor to assess unit training needs and trouble-shoot performance issues.

   2. Unit Performance

  • Reviews reports produced by other departments/units/functions to assess unit performance. Works with Unit Supervisors to adjust work flows, procedures and work assignments as needed or required to maintain and/or improve performance and to meet business needs. Prepares responses as needed. Meets department and program performance standards.
  • Assists unit management in maintaining and controlling or improving workflow(s). Monitors unit’s workflow, inventory and resources and makes adjustments to assignments as required to ensure that unit consistently meets goals and performance expectations.
  • Works with QA Trainer to perform audits of important unit processes. Reports to Section Supervisor on results of audits. Makes recommendations regarding changes to work flows and system improvements and development of training and/or documentation based on results of audits. Maintains records on training and auditing results for performance reviews.

     3. Unit Management 

  • Provides limited Unit oversight when management staff is temporarily unavailable.
  • Provides feedback to unit management regarding problems and presents alternatives and recommendations regarding work flows, employee performance and/or procedural issues.

   4. Administrative 

  • Completes administrative reports based on business needs, program compliance and performance as assigned by management staff.
  • Will serve as a lead on corporate or departmental projects and initiatives as assigned. Project activities can include but are not limited to

    5. Other Duties and Functions 

  • Attend and successfully complete HMSA training classes as assigned.
  • Other duties as assigned.

Minimum Qualifications:

  1. Bachelor’s degree and one (1) year of related experience or equivalent combination of education and experience.
  2. Demonstrated experience in team-building and project coordination.
  3. Proficient in the use of Microsoft Office programs (i.e., Word, Excel, etc).
  4. Strong written and verbal communication skills.
  5. Ability to acquire knowledge of HMSA’s plans and benefits, coding schemes used in HMSA’s business (i.e., CPT-4, ICD9/10-CM, HCPCs) and medical terminology.
  6. Ability to read, analyze and interpret business documents such as HMSA’s Medical Policy Manual, plan certificates, statistical data, marketing memos; Federal and/or state governments’ documentation pertinent to HMSA’s business (i.e., Federal Register, Hawaii Revised Statutes (H.R.S.)
  7. Ability to write reports and correspondence to members, physicians and government agencies.
  8. Ability to speak effectively before groups of employees, various levels of management and individual members, providers and auditors.
  9. May be required to work at either HMSA Center or Kapolei location as needed based on HMSA business needs.
  10. May be required to attend conferences and seminars on the mainland as required by HMSA’s business needs.

EEO/AA/Disability/Vets Employer

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