Research Coordinator

HMSA; Honolulu (HI); Híbrido; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

HMSA in Hawaii is seeking a Provider Services professional to handle case resolution for provider inquiries related to claims, benefits, and medium‑complex issues. You will work with internal teams to gather information and ensure compliant, timely responses.

The role includes cross‑department collaboration, developing education materials for providers, and maintaining staff training programs to improve efficiency and service quality. Hybrid work option available.

Responsabilidades

• Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and medium complex issues.
• Resolves root problems to ensure compliance with contract terms and servicing goals.
• Communicates directly with providers and office staff to develop case information and communicate issue resolution.
• Issues researched and resolved are of medium complexity.
• Participates on cross department workgroups representing Provider Services Department and coordinates system issue resolution.
• Develops education and training material for providers and their staff including workshop presentations and written educational material.
• Coordinates content development with other business areas and gains business approval.
• Coordinates and develops provider communications to ensure information is available to providers timely and accurately.
• Coordinates and maintains Provider Servicing staff training program and trains new employees with ongoing guidance.
• Develops, implements and maintains Department workflows and procedures and participates in process improvements for greater operational efficiency.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

Descripción del empleo

1. Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and medium complex issues that include medical, or payment policy questions and provider appeals. Resolve root problems to ensure compliance with contract terms and servicing goals. Communicates directly with providers and office staff to develop case information and communicate issue resolution. Issues researched and resolved are of medium complexity.
2. Participates on cross department workgroups representing Provider Services Department. Identifies impacts to providers and communicates the provider's perspective to internal business areas. Coordinates system issue resolution and is responsible to facilitate internal and external communications about core system changes and issues. Develops business requirements and test cases to validate system changes and upgrades meet business requirements.
3. Develops education and training material for providers and their staff including workshop presentations and written educational material. Coordinates content development with other business areas and gains business approval. Coordinates and develops provider communications to ensure information is available to providers timely and accurately.
4. Coordinates and maintains Provider Servicing staff training program. Train new employees and supplements training with ongoing guidance and mentoring to research and field staff. Develop and maintain success measurement activities that support department goals.
5. Develops, implements and maintains Department workflows and procedures. Identifies and participates in process improvements for greater operational efficiency.
6. Performs all other miscellaneous responsibilities and duties as assigned or directed.

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