Claims Liaison & Process Improvement Specialist

HMSA; Honolulu (HI); Hybrid; USD 48,000 - 88,000; Full time

Job summary

HMSA in Hawaii is seeking a Claims Liaison to bridge communication between claims processing teams and internal/external partners. You will help ensure information flows clearly and that complex issues are understood and resolved to improve the overall customer experience.

You will investigate escalated claims, coordinate with departments to implement short- and long-term process improvements, support audits and training, and document all interactions in the case management system.

Qualifications

• Associates degree with two years of related experience, or equivalent.
• Effective written and verbal communication skills; ability to present complex issues clearly.
• Knowledge of process improvement methodologies.
• Knowledge of driving increased operational quality in processes.
• Intermediate knowledge of Word, PowerPoint, Outlook and Excel.

Responsibilities

• Serve as central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions.
• Investigate and resolve escalated claims and trends, coordinating with relevant departments to implement short- and long-term solutions and process improvements.
• Manage open claims issues to ensure timely resolution in compliance with SLAs and regulatory standards.
• Collaborate with internal teams to conduct training sessions and measure effectiveness of training.
• Provide support for audits, appeals, and compliance-related activities.
• Participate in system updates and cross-functional meetings to stay current on procedures and benefit plan designs.
• Document all interactions, updates, and outcomes in case management or claims systems.
• Perform other duties as assigned.

Skills

Communication skills

Process improvement

MS Office

Education

Associates degree

Tools

Microsoft Office

Job description

HMSA in Hawaii is seeking a Claims Liaison to bridge communication between claims processing teams and internal/external partners. You will help ensure information flows clearly and that complex issues are understood and resolved to improve the overall customer experience.

You will investigate escalated claims, coordinate with departments to implement short- and long-term process improvements, support audits and training, and document all interactions in the case management system.