Claims Liaison 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

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

• Hybrid Work Environment - Must reside in Hawaii**

Pay Range: $47,500 to $88,000

Note: Individuals typically begin between the minimum to middle of the pay range

The Claims Liaison functions as a bridge between internal and external partners and teams to coordinate communication, cooperation, and understanding. This role ensures that information flows effectively and is understood by all parties involved. The Claims Liaison plays a critical role in enhancing the overall customer experience and supports the integrity of Claims Internal Operations.

Minimum Qualifications

• Associates degree and two years of related work experience; or equivalent combination of education and related work experience.
• Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner.
• Knowledge of process improvement methodologies.
• Knowledge of methodologies for driving increased operational quality....
• Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

Duties And Responsibilities

• Function as a central communication point between claims processing teams and internal/external partners regarding claim status, issues and resolutions.
• Investigate and resolve escalated claims and trends, including denied or delayed claims, by 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 internal 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 claims processing procedures and benefit plan designs.
• Document all interactions, updates, and outcomes clearly in case management or claims systems.
• Performs all other miscellaneous responsibilities and duties as assigned or directed