Member Advocacy & Appeals Specialist II

Hawaii Medical Service Association; Honolulu (HI); Hybrid; USD 51,000 - 69,000; Full time

Job summary

Hawaii Medical Service Association seeks a Full-time, non-exempt administrative professional to support the Member Advocacy and Appeals department. The role involves processing confidential case intake, coordinating communications, and ensuring timely case creation within regulatory requirements.

Pay range is $42,000 - $78,000 annually. Experience with MS Office and strong communication skills are required. This position focuses on accurate file management and responsive member/provider support.

Qualifications

• Associate's degree and one year of related experience; or an equivalent combination of education and related work experience.
• Strong verbal and written communication skills.
• Basic working knowledge of Microsoft Office applications including Word, Excel, and Outlook.

Responsibilities

• Handles intake processes for department cases involving complex confidential issues in a time-sensitive environment.
• Intake of calls, faxes, emails, and referrals; evaluate information to determine best action; follow up to ensure accurate case creation within required timeframe.
• Analyze sensitive member and provider appeals, inquiries, and grievances; apply internal policies, procedures, and regulatory requirements.
• Triage cases to resolve them at initial inquiry/intake to best serve members and reduce escalations.
• Create and maintain electronic case files for appeals and grievances; ensure compliance with policies and regulatory timeframes.
• Handle internal and external customer service calls regarding appeals or grievance requests.
• Communicate clearly with internal/external customers, handle complex issues, and ascertain caller needs to offer excellent service.
• Perform other miscellaneous responsibilities as assigned.

Skills

Verbal and written communication

Education

Associate's degree or equivalent

Tools

Microsoft Word

Excel

Outlook

Job description

Hawaii Medical Service Association seeks a Full-time, non-exempt administrative professional to support the Member Advocacy and Appeals department. The role involves processing confidential case intake, coordinating communications, and ensuring timely case creation within regulatory requirements.

Pay range is $42,000 - $78,000 annually. Experience with MS Office and strong communication skills are required. This position focuses on accurate file management and responsive member/provider support.