Strategic Appeals & Case Resolution Specialist II

HMSA; Honolulu (HI); On-site; USD 60,000 - 80,000; Full time

Job summary

HMSA in Honolulu is seeking a professional to conduct advanced analysis of member and provider appeals, inquiries, and grievances. The successful candidate will serve as a liaison, ensuring compliance with internal policies and regulations while negotiating resolutions and fees.

This role also involves participating in cross-departmental committees, proposing policy changes based on case resolutions, and identifying member and educational needs. Comprehensive communication and analytical skills are essential for success.

Qualifications

• Critical analytical skills for member and provider appeals.
• Negotiation capabilities with multiple stakeholders.
• Proficiency in resolving complex inquiries and complaints.

Responsibilities

• Conduct critical analysis of member and provider appeals.
• Participate in cross-departmental committees to resolve issues.
• Identify member education needs and recommend resolutions.

Job description

HMSA in Honolulu is seeking a professional to conduct advanced analysis of member and provider appeals, inquiries, and grievances. The successful candidate will serve as a liaison, ensuring compliance with internal policies and regulations while negotiating resolutions and fees.

This role also involves participating in cross-departmental committees, proposing policy changes based on case resolutions, and identifying member and educational needs. Comprehensive communication and analytical skills are essential for success.