Supervisor, Claims Administration I (QUEST)

  • Full Time
  • Kapolei
  • Posted 1 week ago

Hawaii Medical Service Association

Job Summary:

This employee mentors, coaches and provides direction for one or more units that are responsible for the processing, adjudication and review of provider and/or member claims, and the implementation of new program changes and/or benefits, work-flows, processes and/or system changes, and other business initiatives as needed or directed.

Duties and Responsibilities:

  1. With minimal direction, selects, trains, develops and organizes examiners and other support staff to use group and individual capabilities to maximize productivity and meet the unit’s business objectives. Provides feedback and coaching (helping individuals to solve problems/issues on their own) to staff including interim and year-end performance reviews.
  2. With some support from either the Section Supervisor or Manager develops unit business plan and budget. Monitors performance based on this plan and budget. With input from QA Trainers and in consultation with Section Supervisor or Manager, makes adjustments in training, performance measurements and auditing for all functions as needed to meet objectives.
  3. Monitors and ensures appropriate cost allocations based on business guidelines. With some direction from section supervisor or manager and in consultation with management team, resolves issues related to improved or enhanced performance that include but are not limited to resource sharing and interactions among units and departments
  4. Ensures program compliance and timely and accurate claims processing with appropriate contracted programs (i.e., Federal Plan 87, State Health Fund Plan) through the management of staff with functions that include but are not limited to appropriate application of HMSA’s benefit and administrative policies through claims adjudication of professional and institutional claims. Ensures development, implementation and administration of programs affecting the overall quality of unit performance that include but are not limited to changes in system and program requirements.
  5. Advises Section Supervisor or Manager of significant matters pertaining to program changes, claims processing and customer servicing.
  6. Attends and completes HMSA training classes as assigned.
  7. Perform other duties as assigned.

Minimum Qualifications:

  1. Bachelor’s degree from college or university in business administration, finance or marketing and two years of related experience with general management or supervisory responsibilities or an equivalent combination of education and experience.
  2. Strong analytical skills.
  3. Working knowledge of Microsoft Office programs (i.e. Word, Excel).

EEO/AA/Disability/Vets Employer

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